Abstract
Fibular free flap (FFF) is the main reconstructive choice for large mandibular defects.
Recent improvements have been made regarding planning and surgical procedure, but
choice of osteosynthesis material (OSM) for segment-fixation remains controversial.
A retrospective cohort study obtained clinical and radiological data from FFF-patients.
Data were screened for OSM, surgical procedure and complications as OSM fractures,
loosening, exposure, or insufficient osseous consolidation. Eighty patients with FFF
were included. Planning was CAD/CAM (n=29), Recon Guide (n=26) or without planning
(n=25). OSM was 2.0mm-miniplates in standard (n=26), preformed (n=6), CAD/CAM (n=14)
or ReconGuide (n=23) variation and 2.3mm-reconstruction-plates in standard (n=5) or
CAD/CAM (n=6) variation. Complications were observed in 21 cases, fractures occurred
10 times overall, but with low rates for preformed (n=1), ReconGuide (n=3) and none
for CAD/CAM. Analysis detected significant correlations between used OSM and plate
exposure (p = 0.000), but none regarding fracture (p = 0.275), loosening (p = 0.714)
or insufficient osseous consolidation (p = 0.208). No correlations were observed between
complications and OSM (p = 0.609) or diagnosis (p = 0.716). Fixation of FFF segments
for reconstruction is possible with various OSM providing good clinical outcome. No
significant differences were detected regarding prevention of complications by any
osteosynthesis material (miniplate vs. macroplate). Although no differences were detected,
miniplate usage is advocated whenever clinically reasonable, due to easier reintervention
possibilities and reduced implanted foreign material. Nevertheless, decision for ideal
OSM must remain patient-specific and cannot be generalised.
Keywords
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Article Info
Publication History
Published online: November 08, 2021
Accepted:
October 30,
2021
Identification
Copyright
© 2021 The British Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.
