Assessment of the differences in the use of free iliac flap for maxillomandibular defects with patient-reported outcomes

Abstract

BACKGROUND: This study investigated the differences from the literature in terms of preoperative and postoperative features, complications, and aesthetic and functional results of patients who underwent a DCIA-based free iliac flap for large maxillomandibular bone defects in our clinic. METHODS: A total of 25 patients who underwent maxillomandibular reconstruction with a free iliac flap were included in the study. The patient files were retrospectively analyzed in terms of perioperative features. Complications and management strategies were reviewed. The functional and aesthetic results of the patients were evaluated with functional and facial appearance evaluation questionnaires. RESULTS: The average age was 42, and the male-to-female ratio was 19:6. The most common indication (11 patients) was gunshot wounds. Mandibular body (B) defects, neck skin (CN), inferior alveolar nerve (NİA), and buccal (B) mucosal defects were the most common defects. Fourteen osteotomies were applied to 11 flaps. Blood transfusion was 1.28 units, operation time 305 minutes, intensive care follow-up time 0.68 days, and hospitalization time was determined as an average of 13.3 days. Twenty-four recipient site and 8 donor site complications were observed. During the functional evaluation of 25 patients, it was observed that 19 patients could be fed a normal diet, 22 had speeches that were easily understood, and the social activity of 4 patients was found to diminish. In the aesthetic evaluation survey of 21 patients, 42.51% of the patients evaluated themselves as excellent/good, 33.3% as acceptable, and 23.8% as bad. When the evaluations were made by plastic surgeons, the patients were evaluated as excellent (19.04%), good (42.85%), acceptable (23.83%), bad (9.52%), and, very bad (4.76%). CONCLUSION: Free iliac flap can be preferred as the first choice for the reconstruction of the orofacial region, especially in trauma patients when its applicability to varied defects in terms of shape, size, content, flap viability, suitability of donor and recipient sites for aesthetic evaluations, and complication rates are considered.