Fibula osteomyocutaneous free flap in mandibular reconstruction: clinical experience in a community-based hospital.

Background: The fibula free flap (FFF) constitutes the gold standard surgical approach for mandibular reconstruction. Mandible reconstruction is routinely performed in high-volume academic centers. To our best knowledge, this is the first case series exclusively dedicated on FFF conducted in community hospitals. This study evaluates our 10-year experience with FFF mandible reconstruction in two community hospitals.Methods: This is a retrospective review of all 12 patients who underwent partial or total mandibulectomy with concomitant mandible reconstruction using FFF from September 2005 through February 2015.Results: The majority of the patients were men (75%) with a mean age of 61 years. Eleven (91.7%) patients had malignancies of the head and neck, and 10 (83.3%) received preoperative XRT. Overall flap survival was 100%, with no arterial/venous thrombosis or malunion. Partial flap failure (with skin paddle necrosis) was reported in only 1 patient, but the bone was viable and survived. Recipient-site wound infection, hardware exposure, and orocutaneous fistula occurred among previously irradiated patients, and in those who were suffering from osteoradionecrosis.Conclusions: Our FFF outcomes were non-inferior to those reported in specialized university hospitals and are evidence that successful results can be obtained outside of high-volume academic centers. FFF represents a reliable surgical approach for mandible reconstruction in university and community hospitals.Level of Evidence: Level IV, therapeutic study. [ABSTRACT FROM AUTHOR]