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