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Objective <p>To evaluate the association between postoperative mean arterial pressure (MAP) and osteocutaneous fibula free flap survival in patients undergoing secondary mandibular reconstruction and to explore an optimal postoperative MAP range.</p> Methods <p>This prospective cohort study included 40 patients undergoing secondary mandibular reconstruction with osteocutaneous fibula free flaps. Postoperative MAP and flap viability were monitored for 72 hours after surgery. Receiver operating characteristic (ROC) analysis was performed to explore the association between MAP and flap outcomes, and potential risk factors for flap failure were evaluated.</p> Results <p>The study included 28 men and 12 women with a mean age of 50.7 ± 12.26 years. ROC analysis identified an exploratory MAP value of 77.17 mmHg; however, this value should not be interpreted as a validated clinical threshold. Because only six flap failures occurred, the ROC performance estimates and regression findings were statistically unstable. Prior radiotherapy and smoking were associated with flap failure in exploratory analyses.</p> Conclusion <p>Postoperative MAP may influence osteocutaneous fibula free flap survival following secondary mandibular reconstruction. However, the proposed MAP value should be interpreted with caution because of the limited number of flap failures. Larger multicenter studies are needed to validate the optimal postoperative MAP range and confirm the identified risk factors.</p>

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The Impact of Mean Arterial Pressure on Fibula Free Flap Survival in Secondary Mandibular Reconstruction

  • 期刊论文

  • 发表日期：

    2026年7月6日

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  • Reza Tabrizi,
  • Zahra Torabi,
  • Elham Babadi,
  • Amir Saleh Khezri,
  • Arash Sarrafzadeh

摘要

Objective

To evaluate the association between postoperative mean arterial pressure (MAP) and osteocutaneous fibula free flap survival in patients undergoing secondary mandibular reconstruction and to explore an optimal postoperative MAP range.

Methods

This prospective cohort study included 40 patients undergoing secondary mandibular reconstruction with osteocutaneous fibula free flaps. Postoperative MAP and flap viability were monitored for 72 hours after surgery. Receiver operating characteristic (ROC) analysis was performed to explore the association between MAP and flap outcomes, and potential risk factors for flap failure were evaluated.

Results

The study included 28 men and 12 women with a mean age of 50.7 ± 12.26 years. ROC analysis identified an exploratory MAP value of 77.17 mmHg; however, this value should not be interpreted as a validated clinical threshold. Because only six flap failures occurred, the ROC performance estimates and regression findings were statistically unstable. Prior radiotherapy and smoking were associated with flap failure in exploratory analyses.

Conclusion

Postoperative MAP may influence osteocutaneous fibula free flap survival following secondary mandibular reconstruction. However, the proposed MAP value should be interpreted with caution because of the limited number of flap failures. Larger multicenter studies are needed to validate the optimal postoperative MAP range and confirm the identified risk factors.