Prevention points for plate exposure in the mandibular reconstruction

• Published in: Journal of cranio-maxillo-facial surgery 2012-12, Vol.40 (8), p.e310-e314
• Main Authors: Onoda, Satoshi, Kimata, Yoshihiro, Yamada, Kiyoshi, Sugiyama, Narushi, Onoda, Tomoo, Eguchi, Motoharu, Mizukawa, Nobuyoshi
• Format: Article
• Language: English
• Subjects: Adult; Aged; Aged, 80 and over; Bone Plates; Carcinoma, Squamous Cell - surgery; Complication; Dentistry; Female; Follow-Up Studies; Graft Survival; Humans; Male; Mandible - surgery; Mandibular Neoplasms - surgery; Mandibular Osteotomy - rehabilitation; Mandibular Prosthesis; Mandibular reconstruction; Middle Aged; Muscle, Skeletal - transplantation; Omentum - transplantation; Postoperative Complications - prevention & control; Preventing plate exposure; Prosthesis Failure; Reconstruction plate; Reconstructive Surgical Procedures - instrumentation; Rectus Abdominis - transplantation; Skin Transplantation - methods; Surgery; Surgical Flaps - transplantation; Treatment Outcome; Vascularised bone grafts
• ISSN: 1010-5182; 1878-4119
• DOI: 10.1016/j.jcms.2012.01.013

Abstract Introduction The rate of complications for mandibular reconstruction after segmental mandibulectomy is higher with reconstruction plates than with vascularised bone grafts. We have experience of over 100 patients using reconstructive plates for reconstruction immediately after segmental mandibulectomy and have considered factors contributing to plate exposure. Patients and methods Seventeen cases utilised our prevention methods in which reconstructive plates were used for mandibular reconstruction were reviewed. The flaps used with reconstruction plates were rectus abdominis myocutanenous flaps in 10 cases, anterolateral thigh flaps combined vastus lateralis muscle in four cases, and the omentum in one case; no flap was transferred in two cases. Results In only one of 17 cases was a plate exposed at 3 months postoperatively. No plate exposure occurred during the follow-up period in the other 16 cases. Because no flap had been transferred in the patient with plate exposure, a possible contributing factor was the persistence of dead space beneath the plate. Conclusion This series suggests that factors other than flap selection contribute to the exposure of reconstructive plates. Use of a reconstruction plate is a useful reconstructive method, especially for patients who cannot tolerate transfer of a vascularised bone graft.