Oral Rehabilitation of Oncology Patients With Microvascular Free Flaps With a Follow-Up of 2 to 6 Years

BACKGROUND: Reconstruction with free flaps after radical cancer surgery in terms of function and esthetics can be quite demanding. The aim of this study was to evaluate retrospectively oral rehabilitation with microvascular free flaps and dental implants for maxillofacial reconstruction in oncologic patients with a minimum follow-up of 2 years after implant insertions.METHODS: The study consisted of 17 patients diagnosed with either squamous cell carcinoma, fusocellular carcinoma, or mucoepidermoid carcinoma. The reconstruction of the maxillofacial defects was done with microvascular free flaps (free fibular flap, antero-lateral thigh flap, or radial forearm flap). Implants were inserted on the average 30.2±15.5 months after reconstructive operations. A total of 74 implants were inserted. Mean follow up after maxillo-facial surgery was 6.16 years (mean 73.93±14.48 months). Mean follow up after implant insertions was 3.61 years (mean 43.50±12.96). Primary outcome was implant survival. Secondary outcome was evaluation of post-surgical complications.RESULTS: There were surgical revisions in seven patients after reconstructive surgery with flaps, mainly due to tumor relapse. Complications were seen in 11 patients. 1 implant was lost in a female patient 15 months after placement. Overall implant survival rate was 97.5%. No relations were found between implant survival rate and gender, type of tumor, type of microvascular free flap, radiation therapy, chemotherapy, and prosthesis type.CONCLUSION: According to the results of this study, oral rehabilitation with dental implants inserted in free flaps for maxillofacial reconstruction after ablative oncologic surgery can be considered as a safe treatment modality with successful outcomes.

Compromised microvascular free flaps; salvage using Fogarty vascular catheter thrombectomy

Compromised free flap perfusion secondary to thrombus formation is a routinely encountered complication in microvascular free tissue transfer. Various modalities were tried out prophylactically to prevent thrombus formation, and likewise, various methods are tried for salvaging the flap with effective thrombectomy. We present the use of Fogarty vascular catheter for thrombectomy and effective salvage of the flap.