Objectives: The aim of this study is to determine objectively predictive factors for postoperative vascular complications in through-and-through COMDs reconstructed with a single fibula flap.
Material & Methods: This was a retrospective cohort study in patients who underwent single free fibular flap reconstruction for through-and-through COMDs in a tertiary medical center from 2011 to 2020. The enrolled patients’ characteristics, surgical methods, thromboembolic event, flap outcomes, intensive care unit care, and total hospital length of stay were analyzed.
Results: A total of 43 consecutive patients were included in this study. Patients were categorized into a group without thromboembolic events (n=35) and a group with thromboembolic events (n=8). The eight subjects with thromboembolic events were failed to be salvaged. There was no significant difference in age, body mass index, smoking, hypertension, diabetes mellitus, and history of radiotherapy. The length of bony defect (6.70±1.95 vs. 9.04±2.96, p=0.004) and the total surface area (105.99±60.33 vs. 169.38±41.21, p=0.004) were the two factors that showed significant difference between the groups. Total surface area was the only significant factor in univariate logistic regression for thromboembolic event (p=0.020, OR 1.02, 95%CI 1.003-1.033) and also in multivariate logistic regression analysis after adjusting confounding factors (p=0.033, OR 1.026, 95%CI 1.002-1.051).
The cut-off level of total surface area in determining thromboembolic event development was 159 cm2 (p=0.005; sensitivity 75% and specificity 82.9%, 95%CI 0.684-0.952).
Conclusions: Free fibula flap has its advantages and drawbacks on mandible restoration. Since there is a lack of indicators before, a large total surface area may be an objective reference for single flap reconstruction of through-and-through COMDs due to elevated risk of thromboembolic event.

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