Clinical Study of Reconstruction Plates Used in the Surgery for Mandibular Discontinuity Defect

Evaluation of aesthetic outcomes of mandibular reconstruction using artificial intelligence

BACKGROUND

Although vascularized bone graft (VBG) transfer is the current standard for mandibular reconstruction, reconstruction with a mandibular reconstruction plate (MRP) and with a soft-tissue flap (STF) alone remain crucial options for patients with poor general conditions. However, objective aesthetic outcome evaluations for these methods are limited.

METHODS

In a retrospective analysis of 65 patients (VBG, 33; MRP, 19; and STF, 13), mandibular asymmetry value was calculated for each patient's photograph using facial recognition AI, with a higher value indicating worse asymmetry.

RESULTS

The MRP group had a value comparable to the VBG group regardless of mandibular defect types. The STF group had a significantly higher value than the VBG group.

CONCLUSIONS

Regarding cosmesis, STF was inferior to VBG, whereas MRP was comparable to VBG, even for anterior defects for which rigid reconstruction is mandatory. However, MRP's risks of plate-related complications limit its use to cases where VBG is contraindicated or with poor prognosis.

LEVEL OF EVIDENCE: 4

Safety of free fibula flap harvest in IIIA and IIIB tibio-peroneal trunk variations

INTRODUCTION

In head and neck cancer malignancies, free fibula flap is the gold standard for reconstruction of segmental bone defects owing to its predictable anatomy, long bone length, and feasibility for multiple osteotomies. However, sometimes because of variations in anatomy of tibio-peroneal trunk, it is a dilemma for the surgeons to use free fibula flap for reconstruction. This case series aimed to evaluate the safety of harvest of fibula in such cases in terms of acute and chronic donor-site complications.

MATERIAL AND METHODS

A retrospective study was conducted from January 2018 to May 2021. All the patients with tibio-peroneal trunk anomaly, diagnosed during surgery, who underwent successful harvest of the free fibula were included in the study and analyzed for the early major and minor donor wound complications, long-term donor complications, and late functional deficit using the Foot and Ankle Disability Index (FADI).

RESULTS

Out of 714 free fibulae operated, 26 patients (3.6%) had such tibio-peroneal trunk variations: 22 (2.9%) cases of type III A and B anomalies and 4 (0.56%) cases of type III C anomalies. The average FADI score was 95.3%. No one had any difficulty in personal care and activity of daily living.

CONCLUSIONS

The free fibula flap can be safely harvested in patients with type III A and B anomalies if vascularity of foot after clamping of peroneal vessels is good and anterior tibial vessels are normal.

Mini-plate versus reconstruction bar fixation for oncologic mandibular reconstruction with free fibula flaps: A systematic review and meta-analysis

Introduction There is currently no consensus as to the comparative complication profiles of mini-plate (MP) and reconstruction bar (RB) osseous fixation in fibula flap mandibular reconstruction. The aim of this study is to compare complication rates associated with the use of MP versus RB fixation for vascularized fibula free flap (FFF) reconstruction of oncologic mandibular defects in an effort to better guide hardware utilization and pre-operative virtual surgical planning methods. Methods A systematic review and meta-analysis was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. PubMed, EMBASE, and Cochrane Library databases were queried to identify studies related to FFF-based mandibular reconstruction with either MP or RB fixation. Primary endpoints of interest were plate complications, wound infection, mal- or non-union, and total flap loss. Complication rates were calculated as weighted proportions and compared via Fisher's exact testing. Results Sixteen studies met inclusion criteria, which examined 1,513 patients. Only three studies directly compared MP fixation with RB fixation. MP fixation was used in 828 (54.7%) cases and RB fixation in 685 (45.3%) cases. MP fixation demonstrated greater rates of plate-related complications (32.5% versus 18.8%, p < 0.01, respectively), fistula formation (15.8% versus 4.7%, p = 0.04), total flap loss (9.4% versus 4.7%, p = 0.02), partial flap loss (20.6% versus 6.1%, p < 0.01), and re-operation for vascular compromise (13.3% versus 4.0%, p < 0.01). Rates of infection, mal-union/non-union, and wound dehiscence were similar across both groups. Conclusion Our results suggest that MP use may be associated with higher rates of plate-related complications. Though limited by outcome reporting heterogeneity, this review can serve as a template for future investigations evaluating the safety profiles of MP and RB fixation in head and neck surgery.

Evaluating the use of anterolateral thigh flaps to prevent reconstruction plate exposure in patients with oral cancer

OBJECTIVE

Plate exposure remains one of the most serious complications of oromandibular reconstruction. The purpose of this study was to investigate the effect of wrapping reconstruction plates with anterolateral thigh (ALT) free flaps as a way to prevent plate exposure.

STUDY DESIGN

A total of 91 patients with composite oromandibular defects who underwent surgical reconstruction using a reconstruction plate in conjunction with an ALT musculocutaneous flap were recruited. The participants were divided into 2 groups, based on whether the plate was wrapped with or covered by the ALT flap.

RESULTS

The incidence of plate exposure in the experimental group (17%) was significantly lower than that of the control group (43.1%; P < .0001). The mean time from reconstruction until plate exposure in the experimental group was 19.4 ± 23.6 months, whereas the mean time in the control group was 12.3 ± 9.1 months. In the logistic regression model for the occurrence of plate exposure, the only factor found to be associated with plate exposure was how the ALT flap was used (P = .026).

CONCLUSIONS

The results of the present study indicate that wrapping the reconstruction plate with an ALT flap decreased the incidence of plate exposure in patients with oromandibular defects.