GP4d - Immediate Teeth in Fibulas Versus Standard Fibula Free Flap: A Comparison of Donor Surgical Site Infections

Abstract: Background
Immediate placement of dental implants with dental restoration at the leg donor site requires implant components and prosthetic materials that are not packaged sterile (1,2).
Purpose
This study aimed to determine if there was a difference in donor surgical site infection between patients that received a fibula free flap with dental implants and immediate teeth prior to flap transfer to the defect site (ITFFF) when compared to standard fibula free flaps without dental implant placement (SFFF).
Study Design
A retrospective cohort study was designed and implemented. The study population was composed of patients who underwent free fibula flap transfer for the treatment of benign or malignant conditions of the head and neck from 2015 to 2022. Patients who received immediate dental implants without teeth were excluded, since those implants are sterile and buried under soft tissue.
Predictor Variable
The surgical treatment with either ITFFF or SFFF was treated as the primary predictor variable.
Outcome Variable
The primary outcome variable was postoperative donor surgical site infection.
Covariates
There were 12 covariate variables including age, sex, diabetes diagnosis, immunosuppression/prior chemotherapy treatment, body mass index, smoking status, pack year history, pathology treated, technique for fibula donor site closure, skin paddle harvest, skin paddle area (cm2), negative pressure wound therapy.
Analyses
For the effect of the covariates on the primary predictor variable, chi-squared analyses and t-tests were used. The effect of the primary predictor variable on the primary outcome was evaluated using chi-squared analysis. A P-value of < .05 was considered statistically significant.
Results
There were 37 patients in the ITFFF group and 47 in the SFFF group. The donor site infection rate for the entire study population was 2.38%. In the ITFFF group there was 1 donor surgical site infection (2.70%) and in the SFFF there was also 1 donor surgical site infection (2.13%). There was no significant difference in donor surgical site infection between the groups (P = .86).
Conclusions
This study found no difference in donor surgical site infection rates between patients who received ITFFF versus SFFF. The overall donor surgical site infection rate following fibula free flap is low.

References
[1] Williams FC, Hammer DA, Wentland TR, Kim RY. Immediate Teeth in Fibulas: Planning and Digital Workflow With Point-of-Care 3D Printing. J Oral Maxillofac Surg. 2020 Aug;78(8):1320-1327.
[2] Williams FC, Hammer DA, Wentland TR, Kim RY. Immediate Teeth in Fibulas: Expanded Clinical Applications and Surgical Technique. J Oral Maxillofac Surg. 2021 Sep;79(9):1944-1953.