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Updated: Sep 6, 2025
A Postoperative Evaluation Guideline for Computer-Assisted Reconstruction of the Mandible
Published on: January 28, 2020
Mini-plate versus reconstruction bar fixation for oncologic mandibular reconstruction with free fibula flaps: A
Nikhil Sobti1, Kaleem S Ahmed2, Thais Polanco1
1Section of Plastic and Reconstructive Surgery, Memorial Sloan Kettering Cancer Center, NY, USA.
Abstract:
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.
Insights
Mini-plate (MP) fixation in fibula flap mandibular reconstruction shows higher rates of plate complications and flap loss compared to reconstruction bar (RB) fixation. This suggests RB may offer a safer alternative for oncologic mandibular defect repair.
Area of Science:
- Oral and Maxillofacial Surgery
- Plastic and Reconstructive Surgery
- Oncology
Background:
- Mandibular reconstruction following oncologic resection presents challenges in achieving stable osseous fixation.
- The choice between mini-plate (MP) and reconstruction bar (RB) fixation for vascularized fibula free flaps (FFF) in mandibular reconstruction lacks consensus regarding complication profiles.
Purpose of the Study:
- To systematically compare complication rates between MP and RB fixation in FFF mandibular reconstruction.
- To inform hardware selection and pre-operative surgical planning for oncologic mandibular defects.
Main Methods:
- Systematic review and meta-analysis adhering to PRISMA guidelines.
- Searched PubMed, EMBASE, and Cochrane Library for studies on FFF mandibular reconstruction with MP or RB fixation.
- Analyzed primary endpoints including plate complications, infection, union, and flap loss.
Main Results:
- MP fixation was associated with significantly higher rates of plate complications (32.5% vs. 18.8%), fistula formation (15.8% vs. 4.7%), and total flap loss (9.4% vs. 4.7%).
- MP fixation also showed increased rates of partial flap loss and re-operation for vascular compromise compared to RB fixation.
- Infection and union rates were comparable between MP and RB groups.
Conclusions:
- Mini-plate fixation in fibula flap mandibular reconstruction may be linked to elevated plate-related complications and flap failure.
- Reconstruction bar fixation appears to have a more favorable safety profile in this context.
- Further research is needed to address outcome reporting heterogeneity and confirm these findings.
