Miniplates Versus Reconstruction Plates in Vascularized Osteocutaneous Flap Reconstruction of the Mandible

Zhang, Zeliang; Wang, Shuai; Sun, C. P.; Xu, Zhongfei

doi:10.1097/scs.0000000000005020

Cited by 19 publications

(15 citation statements)

References 26 publications

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“…In a systemic review of 544 patients by Shang-Ping Liu [73], it found that when miniplates were used with fibular flaps there were 10.3% (56/544) complications, of which 4.8% (26/544) were loosening of the screws, 2.6% (14/544) fracture of the plate, 1.5% (8/544) exposure of the plate, and 6.4% (35/544) infection. There are also literatures that believe that there is no difference between miniplate and traditional plate in the incidence of complications [74], and also there is no difference between mini plate and biodegradable plate [70], so is the conclusion by meta-analysis [75]. Radiotherapy and diabetes increased the incidence rate of plate-related complication [69].…”

Section: Mandibular Reconstructionmentioning

confidence: 99%

Complication of osteo reconstruction by utilizing free vascularized fibular bone graft

Zhou

et al. 2020

BMC Surg

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The success of free vascularized fibular bone graft (FVFBG) has accelerated the osteo reconstruction which results from trauma, resection of a tumor or an infectious bone segment, or correction of congenital deformity. But the complication behind should not be overlooked. The failure could necessitate a second surgery, which prolong the rehabilitation period and produce further health cost. Worst, the patients may suffer a permanent impaired ankle function, or a sustained morpho-functional loss on reconstructive area which are hard to save. To provide an overview of the complication related to reconstruction by FVFBG, a narrative review is conducted to identify the complications including their types and rates, the contributing factors, the approaches to measure and the techniques to avoid. Methodologically, by quick research on Pubmed and abstract reading of reviews, we characterize five reconstructive areas where FVFBG were most frequently applied: extremities, mandible, spine, osteonecrosis of femoral head, and penile. Following, the complications on different reconstructive areas are retrieved, studied and presented in five (or more specifically, six) separate sections. By the way, meaningful difference between FVFBG and other bone flap was presented in a few words if necessary. Donor-site morbidities were studied and summarized as a whole. In these literatures, the evidences documented on limb and mandibular reconstruction have the fullest detail, followed by the spine and lastly the penile. In conclusion, FVFBG, though a mature technique, needs further deep and comprehensive study and maybe device-based assistance to achieve better reconstructive effect and minimize donor-site damage.

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Section: Mandibular Reconstructionmentioning

confidence: 99%

Complication of osteo reconstruction by utilizing free vascularized fibular bone graft

Zhou

et al. 2020

BMC Surg

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“…The use of conventional miniplates for free flap fixation has been described several times ( 16 , 17 ). However, complications also occur with conventional miniplates ( 18 ), and plate fractures are registered more frequently ( 8 ). This is due to pre-determined breaking points during manual bending with forceps and potential poor anatomical reduction of the (joint-carrying) segments, setting the fixation under unfavorable pre-stress ( 19 ).…”

Section: Introductionmentioning

confidence: 99%

Patient-Specific 3D-Printed Miniplates for Free Flap Fixation at the Mandible: A Feasibility Study

et al. 2022

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BackgroundThis study was conducted to evaluate the feasibility, clinical outcomes, and accuracy of patient-specific 3D-printed miniplates for mandible reconstruction with fibula free flaps.MethodsA feasibility study was conducted with 8 patients. Following virtual planning, patient-specific 1.0 mm titanium non-locking miniplates were produced via laser selective melting. 3D-printed cutting and drilling guides were used for segmental mandible resection and flap harvesting. Flap fixation was performed with two 4-hole miniplates and 2.0 mm non-locking screws (screw length 7 mm) for each intersegmental gap. Clinical follow-up was at least 6 months. Preoperative and postoperative CT/cone beam CT data were used for 3D accuracy analysis and evaluation of bone healing. Plate-related complications were monitored clinically.ResultsPatient-specific miniplate fixation of all flaps was successfully conducted (4 mono-segmental, 4 dual-segmental) with high accuracy (3.64 ± 1.18 mm) between the virtual plan and postoperative result. No technical complications were encountered intraoperatively. Osseous union occurred in all intersegmental gaps (1 partial, 18 complete) after 10 ± 2 months. No material fracture, dislocation, or plate exposure was observed.ConclusionsBased on this pilot observational study including a limited number of patients, free flap fixation for mandibular reconstruction with patient-specific 3D-printed miniplates is feasible and associated with high accuracy, bone healing, and remote soft tissue complications.

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“…In a retrospective analysis of 143 mandibular reconstruction patients, no relationship was observed between the use of reconstruction plates or miniplates and complication rate [20]. Similarly, a metaanalysis including 511 patients showed no differences in the use of these two systems of xation; however, clinical records showed that reconstruction plates were associated with both less complications and local exposure in the postoperative period than miniplates [21]. Parise et al retrospectively evaluated 43 patients submitted to mandibular reconstruction with free bular ap [22].…”

Section: Discussionmentioning

confidence: 99%

Thirty-eight-year Follow-up of the First Patient of Mandibular Reconstruction with Free Vascularized Fibula Flap

Puricelli

Chem

2021

Preprint

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Background: The mandible is responsible for vital functions of the stomatognathic system, and its loss results in functional and aesthetic impairment. Mandibular reconstruction with free fibula flap is considered the gold standard for mandibular reconstruction.Case presentation: We describe here the 38-year follow-up of the patient who was the first case of mandibular reconstruction with free fibula flap reported in the literature. The original report describes a 27-year-old woman who had undergone extensive mandibulectomy due to an osteosarcoma. A microvascularized fibula flap was used for mandibular reconstruction in 1983. Two years later, a vestibulo-lingual sulcoplasty with skin graft was performed to allow the construction of a total dental prosthesis. Fifteen years after the initial treatment, an autologous iliac crest graft was placed in the fibula flap, aimed at increasing bone thickness and height for rehabilitation with implant supported prosthesis. In 2015, a rib graft was positioned in the mental region, enhancing the support to the soft tissues of the face and improving the oral function. A recent review of the patient shows well-balanced facial morphology and optimal functional results of the procedure. Conclusions: The fibula flap method, described in 1975 and first reported for mandibular reconstruction in 1985, continues to be applied as originally described, especially where soft tissue damage is not extensive. Its use in reconstructive surgery was expanded by advancements in surgery and techniques such as virtual surgical planning. However, there is still a lack of evidence related to the long-term evaluation of outcomes. The present work represents the longest-term follow-up of a patient undergoing mandibular reconstruction with free vascularized fibula flap, presenting results showing that, even after 38 years, the procedure continues to provide excellent results.

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Miniplates Versus Reconstruction Plates in Vascularized Osteocutaneous Flap Reconstruction of the Mandible

Cited by 19 publications

References 26 publications

Complication of osteo reconstruction by utilizing free vascularized fibular bone graft

Complication of osteo reconstruction by utilizing free vascularized fibular bone graft

Patient-Specific 3D-Printed Miniplates for Free Flap Fixation at the Mandible: A Feasibility Study

Thirty-eight-year Follow-up of the First Patient of Mandibular Reconstruction with Free Vascularized Fibula Flap

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