Your browser doesn't support javascript.
loading
Plate-related complication and health-related quality of life after mandibular reconstruction by fibula flap with reconstruction plate or miniplate versus anterolateral thigh flap with reconstruction plate.
Chang, Tzu-Yen; Lai, Yen-Shuo; Lin, Chung-Ying; Wang, Jung-Der; Pan, Shin-Chen; Shieh, Shyh-Jou; Lee, Jing-Wei; Lee, Yao-Chou.
Affiliation
  • Chang TY; Division of Plastic and Reconstructive Surgery, Department of Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
  • Lai YS; Division of Plastic and Reconstructive Surgery, Department of Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
  • Lin CY; Institute of Allied Health Sciences, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
  • Wang JD; Department of Public Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
  • Pan SC; Division of Plastic and Reconstructive Surgery, Department of Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
  • Shieh SJ; Division of Plastic and Reconstructive Surgery, Department of Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
  • Lee JW; Division of Plastic and Reconstructive Surgery, Department of Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
  • Lee YC; Division of Plastic and Reconstructive Surgery, Department of Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
Microsurgery ; 43(2): 131-141, 2023 Feb.
Article in En | MEDLINE | ID: mdl-35553089
ABSTRACT

BACKGROUND:

Plate-related complications are major long-term complications in mandible reconstruction. There are controversies regarding the use of a reconstruction plate versus miniplates and a bone flap versus a soft tissue flap with a bridging plate. Direct comparisons of a fibula flap and an anterolateral thigh flap, the applicability between a reconstruction plate and miniplate, and the correlation between plate-related complications and quality of life remain unclarified. Therefore, this study aimed to the explore complications of different flaps and plates and how they impact the patients' quality of life.

METHODS:

We retrospectively reviewed the medical records of a total of 205 patients aged >18 years who underwent segmental mandibulectomy and reconstruction using fibula flap with reconstruction plate (FR; n = 86), fibula flap with miniplate (FM; n = 61), and anterolateral thigh flap with reconstruction plate (AR; n = 58) due to cancer ablation, osteoradionecrosis, or benign tumor excision between August 2010 and December 2019. Data on characteristics, complications, and health-related quality of life were collected and analyzed.

RESULTS:

The plate-related complication rate was the highest in the AR group (37.9%), then in the FR group (25.6%), and was the lowest in the FM group (13.1%; p = 0.0079). The plate exposure rate was the highest in the AR group (24.1%), then in the FR group (15.7%), and was the lowest in the FM group (4.9%; p = 0.0128). The plate fracture and dislodge rates for the AR group were both higher than those for the FR and FM groups (24.1% versus 9.3% versus 9.8%, respectively; p = 0.023). The AR group had worse complication-free survival (hazard ratio [HR] 3.61, 95% CI 1.99-6.56, and p < 0.0001) than the FR and FM groups. Osteoradionecrosis (HR 6.19, 95% CI 2.11-18.21, and p = 0.0009) and postoperative radiotherapy (HR 2.87, 95% CI 1.34-6.12, and p = 0.0402) were both independent adverse factors for complication-free survival, whereas patient treated primarily (HR 0.35, 95% CI 0.17-0.73, and p = 0.0048) was an independent protective factor. Plate-related complication negatively impacted the quality of life based on pain scores (ß -0.56, SE 0.26, and p = 0.034).

CONCLUSIONS:

Using a fibular flap fixed with miniplates and avoiding the use of a reconstruction plate may yield a reduced plate exposure rate and better health-related quality of life, particularly for patients with osteoradionecrosis or those who need postoperative radiotherapy.
Subject(s)

Full text: 1 Collection: 01-internacional Database: MEDLINE Main subject: Osteoradionecrosis / Mandibular Neoplasms / Plastic Surgery Procedures / Free Tissue Flaps / Mandibular Reconstruction Aspects: Patient_preference Limits: Humans Language: En Journal: Microsurgery Year: 2023 Document type: Article Affiliation country:

Full text: 1 Collection: 01-internacional Database: MEDLINE Main subject: Osteoradionecrosis / Mandibular Neoplasms / Plastic Surgery Procedures / Free Tissue Flaps / Mandibular Reconstruction Aspects: Patient_preference Limits: Humans Language: En Journal: Microsurgery Year: 2023 Document type: Article Affiliation country: