Use of Flow-through Fibula Flaps in Head and Neck Reconstruction: A Systematic Review

Abstract

Abstract Background The application of the flow-through free fibula flap (FTFFF) in head and neck reconstruction is understudied. This systematic review evaluates indications, techniques, and outcomes of FTFFF in reconstructive surgery. Methods A systematic review of the current literature reviewing FTFFF in head and neck reconstruction was conducted. Patient demographics, defect characteristics, surgical indications and techniques, and postoperative outcomes were collected. Results This review included 19 patients across 10 studies. Median patient age was 47 years (IQR 24.5–55.0); 36.8% were male, 31.6% female, 31.6% not specified. Median follow-up time was 9 months (IQR 6.0–17.0). In all 14 patients (73.7%) underwent mandible-only reconstruction, 3 (15.8%) maxilla-only reconstruction, and 2 (10.5%) combined maxillomandibular reconstruction. Etiologies included oncologic ( n = 16), trauma ( n = 2), and congenital ( n = 1). About 15.7% ( n = 3) underwent preoperative radiotherapy. FTFFF was indicated for defect requiring multiple flaps ( n = 9), lack of skin perforators during harvest ( n = 6), lack of recipient vessels ( n = 4), and TMJ reconstruction ( n = 3). Recipient arteries included facial ( n = 10), external carotid ( n = 5), and superior thyroid ( n = 3); recipient veins included facial ( n = 8), internal ( n = 2) or external jugular ( n = 2), and retromandibular ( n = 1). All flaps survived at 6 months. Complications occurred in 31.5% ( n = 6), consisting of hematoma ( n = 2), venous occlusion ( n = 2), and wound dehiscence ( n = 2). Four patients required immediate reoperation for complications. Planned revisions were performed in 15.8% ( n = 3). Preoperative radiation was not significantly associated with postoperative complications (OR 7.20, 95% CI: 0.48–108.0; p = 0.236). Logistic regression demonstrated that increasing defect size did not increase complication risk. Conclusion The FTFFF can be used in complex head and neck reconstruction, especially in irradiated or traumatized fields with limited recipient vasculature. In conjunction with other flaps, it allows a further degree of rotation and versatility, which is vital in reconstructing composite defects including intraoral surfaces. Complication rates are comparable to traditional fibula flap reconstruction.