Risk Factors for Plate Extrusion After Mandibular Reconstruction With Vascularized Free Flap

West, Jonathan D.; Tang, Liyang; Julian, Alex; Das, Sankha Subhra; Chambers, Tamara; Kokot, Niels

doi:10.1016/j.joms.2021.02.009

Cited by 5 publications

(12 citation statements)

References 40 publications

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“…Swendseid et al [ 30 ] state, that the appearance of partial union or non-union on a routine scan may be a good indicator of future wound problems and that the best segment apposition should be performed [ 30 ]. In a retrospective study including 102 patients, West et al [ 46 ] showed that smoking history, the number of osteotomies, and flap nonviability are all related to plate exposure following mandibular reconstruction. They claimed that long-term results following mandibular reconstruction could be enhanced by reducing surgical problems and performing fewer osteotomies to prevent overly small flap bone segments.…”

Section: Discussionmentioning

confidence: 99%

“…They claimed that long-term results following mandibular reconstruction could be enhanced by reducing surgical problems and performing fewer osteotomies to prevent overly small flap bone segments. Therefore, the number of osteotomies was a risk factor for complications after a fibula-free flap [ 26 , 46 ], which may contribute to partial flap loss [ 47 ].…”

Section: Discussionmentioning

confidence: 99%

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Osseous Union after Jaw Reconstruction with Fibula-Free Flap: Conventional vs. CAD/CAM Patient-Specific Implants

Knitschke

Yonan

Roller

et al. 2022

Cancers

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This is a monocentric, retrospective study of patients who underwent successful immediate or delayed maxilla or mandible reconstructions with FFF from January 2005 to December 2021. Panoramic radiograph, computed tomography scans, and cone-beam CTs were analyzed concerning the osseous union of the intersegmental junctions between maxillary or mandibular native jaw and fibular bone. The primary parameter was to estimate the status of osseous union according to osteosynthesis type. A total number of 133 patients (PSI: n = 64, non-PSI: n = 69) were included in the present study. The mean age was 56.7 ± 14.0 (Range: 14.7–82.7); the primary diagnosis was in 105 patients a malignant (78.9%) and in 20 patients a benign (15.0%) tumor. Mandible reconstruction was performed on 103 patients (77.4%), and on 30 patients (22.6%), maxilla reconstruction was performed. The radiographic images provided a rate of incomplete osseous union (IOU) of about 90% in both groups in the first 6 months. Imaging between 6 and 12 months reveals an IOU rate in the non-PSI group of 46.3% vs. 52.5% in the PSI group, between 12 and 24 months, an IOU rate of 19.6% vs. 26.1%, between 24 and 36 months 8.9% vs. 21.7%, and after 36 months the IOU rate decreases to 4.2% vs. 18.2%. Multivariate logistic regression shows that only osteosynthesis type (OR = 3.518 [95%-CI = 1.223–10.124], p = 0.02) and adjuvant radiotherapy (OR = 4.804 [95%-CI = 1.602–14.409], p = 0.005) are independent risk factors for incomplete osseous union. Cox regression revealed that the variables plate-system (Hazard ratio, HR = 5.014; 95 %-CI: 1.826–3.769; p = 0.002) and adjuvant radiotherapy (HR = 5.710; 95 %-CI: 2.066–15.787; p < 0.001) are predictors for incomplete osseous union. In our study, the rate of incomplete bony fusion was significantly higher in the PSI group. Jaw-to-fibula apposition zones were significantly more affected than intersegmental zones. In multivariate analysis, a combination of osteosynthesis with PSI and adjuvant radiotherapy could be identified as a risk constellation for incomplete ossification.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Osseous Union after Jaw Reconstruction with Fibula-Free Flap: Conventional vs. CAD/CAM Patient-Specific Implants

Knitschke

Yonan

Roller

et al. 2022

Cancers

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“…Segmental resection of the mandible adversely affects mastication, swallowing, and speech and its reconstruction remain one of the main challenges faced by the reconstructive surgeon (van Gemert et al, 2015). The standard of care for segmental mandibular reconstruction is vascularized free flaps (West et al, 2021), but despite improvements in hardware, complications and failure persist and impart morbidity. In this study, we examined the outcomes of fixation methods of free bone flaps used in the reconstruction of segmental mandible defects and identified that secondary reconstruction and preoperative radiation therapy were independently associated with complications such as plate exposure, infection, fistulas, or non‐union in univariate analysis, but only secondary reconstruction remained significant in multivariate analysis, regarding both fixation complications, and plate exposure.…”

Section: Discussionmentioning

confidence: 99%

“…Locking systems, characterized by a geometrical connection between a thread in the screw head and its counterpart in the plate hole (Lieger et al, 2015), have shown several advantages compared with conventional plates, including greater stability of bony segments and flaps, reduced risk of screw loosening, absence of plate pressure on the periosteum, with only minimal effect on the periosteal blood supply, and simplified plate adaptation (Lieger et al, 2015). However, hardware complications such as infection, screw loosening, plate extrusion or even plate fracture persist and they ranged between 3% and 57% of cases (Bauer et al, 2021; Davies et al, 2021; Kreutzer et al, 2021; Prasad et al, 2018; Ritschl et al, 2021; Tsang et al, 2017; West et al, 2021; Wood et al, 2018). Several factors have been shown to increase the risk of hardware complications, including tobacco use, radiotherapy, diabetes, anterior location of the mandibular defect, presence of postoperative complications, type of free flap used, number of osteotomies, and plate contouring (Davies et al, 2021; Ritschl et al, 2021; Tsang et al, 2017; West et al, 2021).…”

Section: Introductionmentioning

confidence: 99%

“…However, hardware complications such as infection, screw loosening, plate extrusion or even plate fracture persist and they ranged between 3% and 57% of cases (Bauer et al, 2021; Davies et al, 2021; Kreutzer et al, 2021; Prasad et al, 2018; Ritschl et al, 2021; Tsang et al, 2017; West et al, 2021; Wood et al, 2018). Several factors have been shown to increase the risk of hardware complications, including tobacco use, radiotherapy, diabetes, anterior location of the mandibular defect, presence of postoperative complications, type of free flap used, number of osteotomies, and plate contouring (Davies et al, 2021; Ritschl et al, 2021; Tsang et al, 2017; West et al, 2021).…”

Section: Introductionmentioning

confidence: 99%

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Risk factors associated with fixation‐related complications in microsurgical free flap reconstruction of the mandible

et al. 2022

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Background Hardware complications (loosening of screws, infection, or exposure of the plate) in mandibular reconstruction with vascularized osseous free flaps impose significant morbidity, and frequently require revision surgery. Purpose of this study was to identify possible contributing factors for hardware complications. Methods This is a retrospective cohort study involving case series of patients who underwent microvascular mandible reconstructions between 2000 and 2020. Patient demographics, pathological, clinical, and treatment‐related factors were analyzed in univariate and multivariate analyses. Results Ninety‐one patients were enrolled, encompassing 63 reconstructions with fibular free flaps, 26 reconstructions with scapular, and 2 reconstructions with iliac flaps. Rate of hardware complications and plate exposure was 14.3% and 7.7%, respectively, with a median follow‐up time for extrusion of 29 months. In univariate analysis, preoperative radiotherapy (odds ratio [OR] = 6.57, p = .01), and secondary mandible reconstruction (OR = 4.3, p = .04) were significant predictors of hardware complications, and plate exposure was most frequently found in secondary reconstruction (37.5%, OR = 11.8, p = .04). Hypertension was the most commonly found comorbidity (24%), and it trended toward significance regarding plate exposure (p = .05). Only secondary mandible reconstruction was associated with osteosynthesis complications (OR = 12.53, p = .01) and plate exposure (OR = 23.86, p = .005) on multivariate analysis, while preoperative radiation therapy did not retain its relevance on plate exposure. Conclusion Secondary mandible reconstructions with vascularized osseous free flaps have a higher risk of osteosynthesis complications than primary reconstructions.

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Risk Factors for Plate Infection, Exposure, and Removal in Mandibular Reconstruction

Shah,

Patel,

Rajasekaran

et al. 2024

Otolaryngol.--head neck surg.

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ObjectiveMandibular plate reconstruction (MPR) is often indicated after tumor ablation, osteoradionecrosis excision, and traumatic bone loss to restore oral functionality and facial cosmetics. There are limited analyses identifying risk factors that lead to plate infection (PIn), exposure, and removal (“plate complications”).Study DesignRetrospective cohort study.SettingAcademic tertiary medical center.MethodsPatients who underwent MPR from 2013 to 2022 were identified. Risk factors for plate complications were analyzed based on demographic, clinical, intraoperative, and postoperative factors. Multivariable analysis was conducted with logistic regression. Survival analysis was conducted with a Cox model.ResultsOf the 188 patients analyzed, 48 (25.5%) had a plate complication [infection: 22 (11.7%); exposure: 23 (12.2%); removal: 35 (18.6%)]. Multivariate analysis revealed predictive associations between at least 1 plate complication and the following variables: smoking status, soft tissue defect size, number of plates, average screw length, and various postoperative complications. Other associations approached the threshold for significance. Prior and adjuvant radiation therapy, type of free flap, stock versus custom plates, and perioperative antibiotic prophylaxis regimens were not associated with plate complications. No plate complication was independently associated with lower overall survival. PIn (hazard ratio, HR: 7.99, confidence interval, CI [4.11, 15.54]) and exposure (HR: 3.56, CI [1.79, 7.08]) were independently associated with higher rates of plate removal.ConclusionPlate complications are relatively common after MPR. Smoking history, specific disease characteristics, hardware used during surgery, and postoperative complications may help identify higher‐risk patients, but additional larger‐scale studies are needed to validate our findings and resolve discrepancies in the current literature.

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Risk Factors for Plate Extrusion After Mandibular Reconstruction With Vascularized Free Flap

Cited by 5 publications

References 40 publications

Osseous Union after Jaw Reconstruction with Fibula-Free Flap: Conventional vs. CAD/CAM Patient-Specific Implants

Osseous Union after Jaw Reconstruction with Fibula-Free Flap: Conventional vs. CAD/CAM Patient-Specific Implants

Risk factors associated with fixation‐related complications in microsurgical free flap reconstruction of the mandible

Risk Factors for Plate Infection, Exposure, and Removal in Mandibular Reconstruction

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