In this retrospective study, the clinical and economic implications of microvascular reconstruction of the mandible were assessed, comparing immediate versus delayed surgical approaches. Utilizing data from two German university departments for oral and maxillofacial surgery, the study included patients who underwent mandibular reconstruction following continuity resection. The data assessed included demographic information, reconstruction details, medical history, dental rehabilitation status, and flap survival rates. In total, 177 cases (131 male and 46 females; mean age: 59 years) of bony free flap reconstruction (72 immediate and 105 delayed) were included. Most patients received adjuvant treatment (81% with radiotherapy and 51% combined radiochemotherapy), primarily for tumor resection. Flap survival was not significantly influenced by the timing of reconstruction, radiotherapy status, or the mean interval (14.5 months) between resection and reconstruction. However, immediate reconstruction had consumed significantly fewer resources. The rate of implant-supported masticatory rehabilitation was only 18% overall. This study suggests that immediate jaw reconstruction is economically advantageous without impacting flap survival rates. It emphasizes patient welfare as paramount over financial aspects in clinical decisions. Furthermore, this study highlights the need for improved pathways for masticatory rehabilitation, as evidenced by only 18% of patients with implant-supported dentures, to enhance quality of life and social integration.
在这项回顾性研究中，我们评估了下颌骨微血管重建的临床与经济影响，对比了即刻与延期手术方案。研究数据来源于德国两所大学口腔颌面外科，纳入了连续性切除术后接受下颌骨重建的患者。评估数据包括人口统计学信息、重建细节、病史、牙齿修复状况及皮瓣存活率。共纳入177例骨性游离皮瓣重建病例（72例即刻重建，105例延期重建；男性131例，女性46例；平均年龄59岁）。多数患者接受了辅助治疗（81%接受放疗，51%接受放化疗联合治疗），主要用于肿瘤切除。皮瓣存活率未受重建时机、放疗状态或切除与重建平均间隔时间（14.5个月）的显著影响。然而，即刻重建显著减少了资源消耗。总体种植体支持性咀嚼功能修复率仅为18%。本研究表明，即刻下颌骨重建具有经济优势，且不影响皮瓣存活率。研究强调临床决策应以患者福祉为首要考虑，而非经济因素。此外，研究指出需改进咀嚼功能修复路径——仅18%患者使用种植体支持义齿的数据表明，提升生活质量与社会融合度仍有较大改善空间。
The Perfect Timing—Immediate versus Delayed Microvascular Reconstruction of the Mandible
肿瘤(癌症)患者之家