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Updated: Feb 27, 2026
Coronoid-Temporalis Pedicled Flap for Orbital Floor Defect Reconstruction
Published on: December 5, 2025
Hardware complications in oromandibular defects: Comparing scapular and fibular based free flap reconstructions
Gordon F Z Tsang1, Han Zhang2, Christopher Yao3
1Department of Otolaryngology-Head & Neck Surgery/Surgical Oncology, Princess Margaret Cancer Centre, University Hospital Network, Toronto, Ontario, Canada; Department of Otolaryngology-Head & Neck Surgery, Toronto, Ontario, Canada.
Background:
Despite improvements in surgical technique and technology, hardware complications occur relatively frequently. This study analyzes hardware complications in patients undergoing oromandibular reconstruction using scapular (SFF) or fibular (FFF) free flaps.
Methods:
Retrospective data for 178 patients was obtained (1999-2014) at University Hospital Network (Toronto, Canada). Univariable and multivariable analyses were performed to identify risk factors for hardware complications.
Results:
Patients with FFF reconstruction (n=129) had significantly more hardware complications than those with SFF (n=49) (16% vs. 2%;p=0.01). Surgical site infection (SSI) (OR=7.05; p<0.01), defect type (OR=2.63; p<0.01) and flap (OR=0.12; p=0.01) were significant predictors of hardware complications on univariable analysis. Flap type (OR=0.12; p=0.04) was an independent predictor of plate complication after adjusting for SSI. A subgroup analysis suggested a trend towards fewer hardware complications with SFF stratified by mandibular defect type.
Conclusions:
Scapular free flaps are associated with a lower rate of hardware-related complications in oromandibular reconstruction.
