Comparing Fibula and Osteocutaneous Radial Forearm Free Flaps: A 20-Year Retrospective Review.

OBJECTIVES: Fibula free flaps and osteocutaneous radial forearm flaps (OCRFFFs) may be used to reconstruct complex head and neck defects following cancer ablation and trauma. This study aimed to compare the reconstructive outcomes of defects rehabilitated with fibula or OCRFFFs. METHODS: Retrospective chart review completed over 20 years of adult patients greater than 18 years of age undergoing reconstruction of head and neck defects with fibula or OCRFFFs. RESULTS: Total patients: 52. Reconstruction type: 26/52 (50%) fibula, 26/52 (50%) OCRFFF. Mean surgical time: 697 min fibula, 576 min OCRFFF (p = 0.002). Charlson Comorbidity Index: 4.6 fibula, 4.7 OCRFFF (p = 0.43). There was no significant difference in flap survival rate. Survival rates of both fibula and OCRFFFs: 23/26 (88%) survived, 2/26 (8%) total loss, 1/26 (4%) partial flap loss (p > 0.99). There was no significant difference in post-operative complications between flap types. Post-operative complications: 10/26 (38%) fibula, 9/26 (35%) OCRFFF (p > 0.99). There was no significant difference in post-operative infection rate. Post-operative infection rate: 7/26 (27%) fibula, 7/26 (27%) OCRFFF (p > 0.99). There was no significant difference in post-operative length of stay. Post-operative length of stay: 11.6 days fibula, 14.0 days OCRFFF (p = 0.26). CONCLUSION: OCRFFFs provide reconstruction of composite defects with significantly shorter operative times compared to fibula flaps. Post-operative flap survival and complication rates were similar in both fibula and OCRFFF reconstructions. Although OCRFFFs may not undergo dental implantation as the bone stock is thin, the flap may optimally reconstruct composite defects in patients unable to undergo prolonged procedures. LEVEL OF EVIDENCE: 3.