{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,12,26]],"date-time":"2025-12-26T23:42:08Z","timestamp":1766792528194,"version":"3.48.0"},"reference-count":21,"publisher":"Georg Thieme Verlag KG","issue":"01","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J Reconstr Microsurg"],"published-print":{"date-parts":[[2026,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>Midface reconstruction should address both functional and cosmetic aspects. The vascularized fibular osteomyocutaneous flap (VFOF) is a promising first choice because of its numerous advantages in this type of reconstruction.<\/jats:p>\n                  <jats:p>This study aimed to investigate the causes of VFOF failure during midface reconstruction. We retrospectively reviewed patients who underwent midface defect reconstruction using VFOF from August 2011 to May 2022 at a single center. The primary outcome variable was VFOF loss within 30 days, and secondary outcomes included late complications related to VFOF occurring at least 6 months postoperatively.<\/jats:p>\n                  <jats:p>A total of 62 patients underwent VFOF reconstruction for midface defects. The VFOF technique was primarily used in 56 (90.3%) patients for initial reconstruction. according to the Brown and Shaw classification, most reconstructions were performed for Class III (77.4%) and Class b (83.6%) defects. Skin paddles of the VFOF were used in 51 (82.3%) patients, and a double flap technique utilizing the fibular was employed in 24 (38.7%) patients. VFOF failure occurred in 10 (16.1%) patients. Prognostic factors associated with VFOF failure included sex (p\u2009=\u20090.01) and maxillary Brown and Shaw classification (horizontal; p\u2009=\u20090.01). Long-term follow-up of 47 patients revealed late complications in 11 (23.4%) patients, and diabetes mellitus was identified as a significant risk factor (p\u2009&lt;\u20090.01).<\/jats:p>\n                  <jats:p>The VFOF is suitable for midface defect reconstruction; however, proper placement of the fibular bone, avoiding pedicle vessel kinking, ensuring tension-free vascular anastomosis during surgery, considering the use of an additional flap in addition to the fibula flap for large defects, and diligent postoperative nasal care are essential.<\/jats:p>","DOI":"10.1055\/a-2555-2169","type":"journal-article","created":{"date-parts":[[2025,3,11]],"date-time":"2025-03-11T21:01:46Z","timestamp":1741726906000},"page":"060-071","source":"Crossref","is-referenced-by-count":0,"title":["Risk Factors for Flap Loss in Midface Reconstruction with Vascularized Fibular Flap"],"prefix":"10.1055","volume":"42","clinical-trial-number":[{"clinical-trial-number":"umin000054486","registry":"10.18810\/umin-japan"}],"author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4604-0847","authenticated-orcid":false,"given":"Katsuhiro","family":"Ishida","sequence":"additional","affiliation":[{"name":"Department of Plastic and Reconstructive Surgery, Jikei University School of Medicine, Tokyo, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yohjiro","family":"Makino","sequence":"additional","affiliation":[{"name":"Department of Plastic and Reconstructive Surgery, Jikei University School of Medicine, Tokyo, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Keita","family":"Kishi","sequence":"additional","affiliation":[{"name":"Department of Plastic and Reconstructive Surgery, Jikei University School of Medicine, Tokyo, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hiroki","family":"Kodama","sequence":"additional","affiliation":[{"name":"Department of Plastic and Reconstructive Surgery, Jikei University School of Medicine, Tokyo, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Haruyuki","family":"Hirayama","sequence":"additional","affiliation":[{"name":"Department of Plastic and Reconstructive Surgery, Jikei University School of Medicine, Tokyo, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Doruk","family":"Orgun","sequence":"additional","affiliation":[{"name":"Department of Plastic and Reconstructive Surgery, Jikei University School of Medicine, Tokyo, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Masaki","family":"Nukami","sequence":"additional","affiliation":[{"name":"Department of Plastic and Reconstructive Surgery, Jikei University School of Medicine, Tokyo, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Taisuke","family":"Akutsu","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology, Head and Neck Surgery, Jikei University School of Medicine, Tokyo, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Takeshi","family":"Miyawaki","sequence":"additional","affiliation":[{"name":"Department of Plastic and Reconstructive Surgery, Jikei University School of Medicine, Tokyo, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"194","published-online":{"date-parts":[[2025,3,27]]},"reference":[{"issue":"01","key":"ref1","doi-asserted-by":"crossref","first-page":"124","DOI":"10.1097\/PRS.0b013e318221dca4","article-title":"A 15-year review of midface reconstruction after total and subtotal maxillectomy: part I. 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Surg"},{"issue":"02","key":"ref8","first-page":"93","article-title":"The Eighth Edition AJCC Cancer Staging Manual: Continuing to build a bridge from a population-based to a more \u201cpersonalized\u201d approach to cancer staging","volume":"67","author":"M B Amin","year":"2017","journal-title":"CA Cancer J Clin"},{"issue":"02","key":"ref9","doi-asserted-by":"crossref","first-page":"161","DOI":"10.1001\/archotol.128.2.161","article-title":"Midface reconstruction with the fibula free flap","volume":"128","author":"N D Futran","year":"2002","journal-title":"Arch Otolaryngol Head Neck Surg"},{"issue":"09","key":"ref10","doi-asserted-by":"crossref","first-page":"2623","DOI":"10.1002\/hed.26731","article-title":"Maxillectomy defects: Virtually comparing fibular and scapular free flap reconstructions","volume":"43","author":"S Nguyen","year":"2021","journal-title":"Head 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palatomaxillary reconstruction using regional and free tissue transfer: Report of reconstructive and prosthodontic outcomes of 140 patients","volume":"40","author":"M L Urken","year":"2018","journal-title":"Head Neck"},{"issue":"02","key":"ref18","doi-asserted-by":"crossref","first-page":"371","DOI":"10.3171\/2018.10.JNS181556","article-title":"Various modifications of a vascularized nasoseptal flap for repair of extensive skull base dural defects","volume":"132","author":"J H Moon","year":"2019","journal-title":"J Neurosurg"},{"issue":"03","key":"ref19","doi-asserted-by":"crossref","first-page":"193","DOI":"10.1055\/s-0037-1607394","article-title":"Staged reconstruction (delayed-immediate) of the maxillectomy defect using CAD\/CAM technology","volume":"34","author":"J H Pang","year":"2018","journal-title":"J Reconstr Microsurg"},{"key":"ref20","doi-asserted-by":"crossref","first-page":"106860","DOI":"10.1016\/j.oraloncology.2024.106860","article-title":"Retrospective study of the deep circumflex iliac artery flap and the vascularized fibula free flap for maxillary defect repair","volume":"154","author":"C Q Li","year":"2024","journal-title":"Oral Oncol"},{"issue":"01","key":"ref21","doi-asserted-by":"crossref","first-page":"143e","DOI":"10.1097\/PRS.0000000000010142","article-title":"Maxillomandibular reconstruction using insourced virtual surgical planning and homemade CAD\/CAM: A single-center evolution in 75 patients","volume":"152","author":"J J Vranckx","year":"2023","journal-title":"Plast Reconstr Surg"}],"container-title":["Journal of Reconstructive 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