Maxillo-Mandibular Reconstruction: Is the Donor Site Morbidity a Real Issue in Selecting Process of Osteocutaneous Free Flap? Comparison Between DCIA Flap and Fibula Flap
2Dipartimento di Scienze Odontostomatologiche e Chirurgia Maxillo-Facciale, U.O.D. Chirurgia Oncologica Ricostruttiva Maxillo-Facciale - Policlinico Umberto I di Roma
Objectives: Maxillo-mandibular reconstruction aims to restore facial anatomy and function. The choice of which tissue to use is influenced by several factors: extension of resected bone, soft tissue needed, availability of ipsilateral vessels in the neck. Other important factors that we can’t forget are the patients characteristics and the donor site morbidity. The aim of this study was to discuss the advantages and disadvantages of deep Circumflex iliac crest artery (DCIA) flap and fibula free (FF) flap and comparing the subjective and objective morbidity.
Methods: It is a retrospective study and 41 patients were enrolled, inclusion criteria were: reconstruction with FFF or DCIA after maxillo-mandibular resection treated in our Department between 2010 to 2018. Perioperative and Long-term donor-site complications were registered. To evaluate the long-term donor-site complications we used The University of Washington Quality of Life test, the Stony Brook Scar Evaluation Scale and in FFF group we used the Ankle-hindfoot and the Harris-hip scoring systems to evaluate DCIA group.
Results: Our results show an high rate of perioperative donor-site complications in FFF group then DCIA group. On the contrary, early complications are more severe in DCIA group than FFF group. University of Washington Q.o.L. score it has been extrapolated for each group and there is no difference between patients treated by FFF or DCIA flap. The Stony Brook Scar Evaluation Scale in FFF group the mean value was 3,6 and 4.7 in DCIA group. AOFAS Ankle Score in FFF group is 86. The Harris hip scoring system used for DCIA group show 89 mean values.
Conclusion: Our results demonstrate that an accurate selection of the flap based on the characteristics of the recipient site and of the donor site reduces the donor site morbidity. Donor site morbidity should not represent a key factor in the choice of the best reconstructive option.
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