Microvascular reconstruction in oral and maxillofacial surgery: a Europe-wide data collection

Philipp Becker; Alexander-N Zeller; Elisabeth Goetze; Behrus Puladi; Frank Hölzle; Jürgen Hoffmann; Jan Dirk Raguse; Kai Wermker; Andreas Pabst

doi:10.1007/s10006-025-01344-4

Microvascular reconstruction in oral and maxillofacial surgery: a Europe-wide data collection

Oral Maxillofac Surg. 2025 Jan 23;29(1):42. doi: 10.1007/s10006-025-01344-4.

Authors

Philipp Becker^#^{1

2}, Alexander-N Zeller^#^{3

4}, Elisabeth Goetze⁵, Behrus Puladi⁶, Frank Hölzle⁶, Jürgen Hoffmann⁷, Jan Dirk Raguse⁸, Kai Wermker⁹, Andreas Pabst^{10

11

12}

Affiliations

¹ Department of Oral and Maxillofacial Surgery, German Armed Forces Central Hospital, Rübenacherstr. 170, 56072, Koblenz, Germany.
² Department of Oral and Maxillofacial Surgery, University Medical Center Mainz, Augustusplatz 2, 55131, Mainz, Germany.
³ Private Practice for Oral and Maxillofacial Surgery, Theaterstr. 61, 52062, Aachen, Germany.
⁴ Department of Oral and Maxillofacial Surgery, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany.
⁵ Department of Oral and Maxillofacial Surgery, University Hospital Zurich, Rämistr. 100, Zurich, 8091, Switzerland.
⁶ Department of Oral and Maxillofacial Surgery, University Hospital RWTH Aachen, Pauwelstr. 30, 52074, Aachen, Germany.
⁷ Department of Oral and Maxillofacial Surgery, University Hospital Heidelberg, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany.
⁸ Department of Oral and Maxillofacial Surgery, Specialist Clinic Hornheide, Dorbaumstr. 300, 48157, Münster, Germany.
⁹ Department of Oral and Maxillofacial Surgery, Osnabrück Clinic, Am Finkenhügel 1, 49076, Osnabrück, Germany.
¹⁰ Department of Oral and Maxillofacial Surgery, German Armed Forces Central Hospital, Rübenacherstr. 170, 56072, Koblenz, Germany. [email protected].
¹¹ Department of Oral and Maxillofacial Surgery, University Medical Center Mainz, Augustusplatz 2, 55131, Mainz, Germany. [email protected].
¹² Lieutenant Colonel (Medical Service, Department of Oral and Maxillofacial Surgery, German Armed Forces Central Hospital, Rübenacherstr. 170, 56072, Koblenz, Germany. [email protected].

^# Contributed equally.

PMID: 39847127
DOI: 10.1007/s10006-025-01344-4

Abstract

Purpose: This study aims to analyze microvascular reconstruction in Oral and Maxillofacial Surgery (OMFS) in Europe.

Methods: Based on previous studies, a dynamic online questionnaire was developed and subjected to internal and external evaluation. The questionnaire comprised multiple-choice, rating, and open-ended questions, addressing general and specific aspects and the impacts of the COVID-19 pandemic on microvascular reconstruction in OMFS in Europe. It was implemented into SurveyMonkey's^® online survey software and emailed to OMFS departments registered with the European Association for Cranio-Maxillofacial Surgery (EACMFS).

Results: Seventy-five participants from 23 European countries participated. Among them, 89% perform between 1 and 70 microvascular free flaps (MFF) annually. 38% of the participants reported a reduction in MFF due to the COVID-19 pandemic. The radial forearm (41% of participants) and fibula free flap (31%) are the most reported MFF. In most cases (59%), MFF procedures are exclusively performed by OMFS for OMFS patients, while 43% of participants reported cooperations with plastic surgeons to perform MFF for OMFS patients. Many participants prefer arterial end-to-end anastomoses (54%) using the facial artery (54%) and, if available, two venous anastomoses (68%). Low molecular weight heparin is the most used postoperative anticoagulant, reported by 67% of participants. For flap monitoring, clinical assessment and Doppler ultrasound are preferred by most participants (95% and 78%, respectively). Many participants (66%) indicated that tracheotomy is only performed when necessary. Differences were observed in relation to CAD/CAM (Computer-Aided Design/Computer-Aided Manufacturing) techniques, types of osteosynthesis, and dental implant treatment.

Conclusion: This study highlighted variability in microvascular reconstruction in OMFS in Europe. Further studies are needed to assess these aspects in detail.

Keywords: Europe; Microsurgery; Microvascular free flap; Reconstruction; Survey.

MeSH terms

COVID-19*
Europe
Free Tissue Flaps* / blood supply
Humans
Microsurgery / methods
Oral Surgical Procedures / methods
Pandemics
Plastic Surgery Procedures* / methods
Surveys and Questionnaires