Hyun Il Kang

Aim: To evaluate the clinical outcomes of double-strut fibula onlay bone graft combined with a vascularized fibula free flap for mandibular reconstruction, focusing on long-term graft volume changes and viability. Materials and Methods: This retrospective review included 9 patients (7 males, 2 females) who underwent simultaneous reconstruction with a fibula free flap and fibula onlay bone graft between 2017 and 2023. The mean follow-up period was 2.19±1.69 years. Clinical and radiologic data were collected to assess bone volume, speech, dietary function, and postoperative complications. Volumetric analysis was conducted using 3D imaging, and the Mann-Whitney U test was used to compare bone volume changes between the graft and flap groups. Results: The mean fibula onlay graft length was 5.9±1.7 cm (range: 2.8 to 7.6 cm). Postoperative imaging showed higher bone volumes in the fibula flap group at all time points. The onlay graft group exhibited a higher median percentage bone volume reduction (43.48%) compared with the fibula flap group (22.37%), although this difference did not reach statistical significance ( P =0.136), and the series was too small to exclude a clinically meaningful difference. Bone union was achieved in 88.9% of cases, with 1 graft failure (11.1%) and 1 wound infection (11.1%). Conclusion: In this small, uncontrolled series, the combination of a periosteal-preserving fibula onlay bone graft with a vascularized fibula free flap was feasible and achieved vertical augmentation with acceptable graft viability and a low complication rate. Larger controlled studies are required before the technique can be recommended over established alternatives.

Background and Objectives: Head and neck cancer (HNC) frequently necessitates reconstructive surgery due to defects following oncologic resection. The influence of age on reconstructive outcomes in head and neck cancer remains controversial. This study aimed to evaluate the impact of age on oncologic characteristics, reconstructive strategies, and functional outcomes following microvascular free flap reconstruction. Materials and Methods: A retrospective review was conducted on 286 patients who underwent free flap reconstruction for head and neck cancer between 2016 and 2020. Patients were stratified into three age groups: 60 years. Demographic characteristics, tumor features, reconstructive approaches, complications, and functional outcomes—including postoperative dietary tolerance and tube feeding dependency—were analyzed. Results: The oral cavity was the most common tumor site across all age groups. Advanced-stage tumors (T4) were more frequently observed in older patients (>60 years), although the difference was not statistically significant (p = 0.0575). The overall flap survival rate was 98.6%. The mean hospital stay was 24.6 ± 15.86 days and was significantly longer in the >60-years group (p < 0.001). Postoperative dietary tolerance was comparable across age groups, with 56.8% of patients resuming a regular diet. Tube feeding dependency was slightly higher in the >60-years group but did not reach statistical significance (p = 0.1599). Conclusions: Age alone does not significantly affect reconstructive outcomes following microvascular free flap reconstruction for head and neck cancer. Despite a higher prevalence of comorbidities in and longer hospital stays for older patients, flap success rates and functional outcomes were comparable across age groups.