Hardware removal after osseous free flap reconstruction.

Area of Science:

• Oral and Maxillofacial Surgery
• Plastic Surgery
• Biomaterials Engineering

Background:

• Mandibular reconstruction with vascularized osseous free flaps is a complex procedure.
• Hardware complications, such as removal, can impact patient outcomes.
• Identifying risk factors for hardware removal is crucial for improving reconstructive surgery success.

Purpose of the Study:

• To identify risk factors for hardware removal in patients undergoing mandibular reconstruction.
• To compare hardware removal rates between osteocutaneous radial forearm free flaps and fibular flaps.
• To describe the outcomes and fate of implanted hardware after removal.

Main Methods:

• A retrospective case series design was employed.
• Data were collected from 213 patients who underwent 227 vascularized osseous mandibular reconstructions between 2004 and 2012.
• Manual chart review was used to identify patients requiring hardware removal.

Main Results:

• Hardware removal occurred in 16% (34/213) of cases, with a median time to removal of 10 months.
• Osteocutaneous radial forearm free flaps had a higher hardware removal rate (9.9%) compared to fibula flaps (6.1%).
• Infection or exposure were the most common reasons for hardware removal, typically within the first year.

Conclusions:

• Continued tobacco use post-reconstruction was significantly associated with hardware removal (P = .03).
• Hardware removal is most frequently necessitated by infection or exposure within the first year after surgery.
• In most instances, the underlying bone heals successfully following hardware removal, resolving the complication.