Hardware complications in oromandibular defects: Comparing scapular and fibular based free flap reconstructions

Tsang, Gordon; Zhang, Han; Yao, Christopher M. K. L.; Kolarski, Mirko; Gullane, Patrick; Irish, Jonathan C.; Brown, Dale; Chepeha, Douglas B.; Goldstein, David P.; Gilbert, Ralph W.; Almeida, John R. de

doi:10.1016/j.oraloncology.2017.06.020

Cited by 27 publications

(74 citation statements)

References 23 publications

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“…Interestingly and consistent with our findings, a recent experience from another Canadian referral center (Tsang et al, ) also compared hardware complications (defined as exposure, infection, fracture, and removal) between FFFs and STFFs. In their final multivariate analysis STFF had has a lower risk of hardware complication.…”

Section: Discussionsupporting

confidence: 90%

“…Many head and neck cancer patients are poor candidates for dental implantation due to radiotherapy, poor dental hygiene, lower socioeconomic status, and trismus (Dholam, Pusalkar, Yadav, Quazi, & Somani, ) among other factors resulting in a very small portion of our population being rehabilitated. Our institutional algorithm prioritizes the theoretical benefits of the scapular flap (better vessel quality, early deambulation, better soft tissue coverage) over the potential superior implantability of the fibular free flaps (Dowthwaite et al, ; Tsang et al, ; Yoo et al, ).…”

Section: Discussionmentioning

confidence: 99%

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Predictors of plate extrusion in oromandibular free flap reconstruction

et al. 2018

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At our institution, use of the STFF predicts mandibular defects that are less prone to developing plate extrusion and FFF tended to be used more frequently in anterior defects with osteotomies. However, after controlling for these factors use of the FFF appeared to have higher rates of extrusion than scapular flaps. Further prospective studies controlling for defect variables are needed to elucidate the risk factors for plate extrusion.

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Section: Discussionsupporting

confidence: 90%

Section: Discussionmentioning

confidence: 99%

Predictors of plate extrusion in oromandibular free flap reconstruction

et al. 2018

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“…This is particularly true in cases where double flaps would not be ideal such as in a vessel depleted neck, elderly/frail patients, or in cases of palliative surgery. Furthermore, in comparison with the fibula flap, the additional soft tissue available with the chimeric scapula tip flap aids to reduce dead space in the wound bed and allow for extensive coverage of plating hardware . As shown in a previous study from our center on plate related complications, only 3.3% of patient required hardware removal despite surgical wound complications and a orocutaenous fistula rates consistent with the literature .…”

Section: Discussionsupporting

confidence: 85%

Mandibular reconstruction with the scapula tip free flap

et al. 2019

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Introduction: The scapula tip free flap has been described for reconstruction of short mandible defects with extensive soft tissue needs. The versatility of this flap has not been extensively described. Methods: Retrospective case series of patients who underwent mandibulectomy and reconstruction with the scapula tip free flap from 2005 to 2016. Outcomes include bony union, complications, dental rehabilitation, and donor site morbidity. Results: A total of 120 patients were identified. Average harvested bone was 7.7 cm, with 54% undergoing one osteotomy, and 76.7% harvested as a chimeric flap. Radiographically, average inset bone was 6.6 cm. Complete or partial bony union was observed at 74.4% of proximal and 82.6% of distal osteotomies. A 95% of reconstructions met criteria for dental implants. Mean disabilities of the arm, shoulder and hand score was 21.2. Conclusions: The scapular tip is an excellent option for reconstruction of segmental mandible defects with the option of osteotomy, excellent bony union rates, low donor site morbidity, and potential for dental rehabilitation.

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“…In this study, there was no significant difference in complication rate or reoperation rate between reconstructive flap type. Additionally, data exist to suggest that the size of the reconstructed mandibular defect correlates with an increasing complication rate; this may be another independent risk factor for plate‐related complications . Arganbright et al demonstrated that patients are 1.3 times more likely to have plate exposure for every 1‐cm increase of bone harvest length in patients receiving radial forearm free flaps .…”

Section: Discussionmentioning

confidence: 99%

“…Additionally, data exist to suggest that the size of the reconstructed mandibular defect correlates with an increasing complication rate; this may be another independent risk factor for plate-related complications. 16,18 Arganbright et al demonstrated that patients are 1.3 times more likely to have plate exposure for every 1-cm increase of bone harvest length in patients receiving radial forearm free flaps. 17 Although we did record graft length for each patient, we did not stratify plate-related complications and reoperation in the context of graft length.…”

Section: Discussionmentioning

confidence: 99%

Comparison of Modern Rigid Fixation Plating Outcomes for Segmental Mandibular Microvascular Reconstruction

et al. 2018

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Objectives/Hypothesis New advances in osseous microvascular mandibular rigid fixation are being employed at many institutions. These include standardized prebent/preformed reconstruction plates as well as computer‐aided design/computer‐aided manufacturing (CAD/CAM) custom plates that are patient specific. Our goal was to assess and compare the outcomes of both of these new technologies when utilized for mandibular microvascular reconstruction. Study Design Retrospective chart review. Methods Subjects were categorized into two groups according to their mandibular rigid fixation technique: group 1 = prebent/preformed plates and group 2 = CAD/CAM custom plates. Primary outcome measures were 1) perioperative complications (defined as deep tissue infection, wound dehiscence resulting in bone exposure, and/or plate exposure) and 2) reoperation rates for mandibular hardware failure/explantation. Statistical analysis consisted of χ2, Fisher exact test, and multivariable regression models. Results A total of 142 subjects underwent microvascular mandibular reconstruction in a 6‐year period. Eighty‐nine subjects utilized prebent/preformed plates, and 53 employed CAD/CAM custom plates. Perioperative complications occurred in 32 of 89 (35.9%) subjects with prebent/preformed plates and 11 of 53 (20.7%) subjects using CAD/CAM custom plates. Reoperation requiring hardware explantation occurred in 18 of 89 (20.2%) subjects and three of 53 (5.6%) using CAD/CAM custom plates. Statistical comparison of perioperative complications between the two groups approached significance (P = .0556), and the rate of reoperation was significant favoring CAD/CAM implants (P = .0180). Conclusions In our experience, CAD/CAM custom plates utilized for rigid fixation during microvascular mandibular reconstruction demonstrated fewer complications and statistically lower reoperation rates when compared with prebent/preformed plates. Level of Evidence 2c Laryngoscope, 129:1081–1086, 2019

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Hardware complications in oromandibular defects: Comparing scapular and fibular based free flap reconstructions

Cited by 27 publications

References 23 publications

Predictors of plate extrusion in oromandibular free flap reconstruction

Predictors of plate extrusion in oromandibular free flap reconstruction

Mandibular reconstruction with the scapula tip free flap

Comparison of Modern Rigid Fixation Plating Outcomes for Segmental Mandibular Microvascular Reconstruction

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