Long-Term Plate Complications in Patient-Specific Plates Utilizing Computer-Aided Design.

Area of Science:

• Oral and Maxillofacial Surgery
• Reconstructive Surgery
• Biomaterials Engineering

Background:

• Mandibular defects often require complex reconstructions, with fibula free flaps being a common solution.
• Patient-specific plates (PSPs), designed using computer-aided design (CAD) and computer-aided manufacturing (CAM), offer tailored fit for these reconstructions.
• Long-term complications associated with PSPs in this context require thorough evaluation.

Purpose of the Study:

• To assess the incidence and nature of long-term plate-related complications in patients undergoing mandibular reconstruction with fibula free flaps utilizing PSPs.
• To identify factors influencing the risk of plate complications in this patient population.

Main Methods:

• A retrospective chart review was conducted for 221 patients who received fibula free flap reconstruction with PSPs between January 2010 and July 2022.
• The primary outcome measured was plating-related complications, including plate exposure, fracture, screw loosening, and the need for plate removal.
• Statistical analysis was performed to identify associations between patient factors, treatment variables, and plate complications.

Main Results:

• Plate removal occurred in 11% of patients, primarily due to exposure (76%) or screw loosening (24%), at an average of 17.4 months post-surgery.
• Malignancy as the reason for resection, postoperative radiation therapy, and surgical site infections were significantly associated with an increased risk of plate complications.
• Odds ratios indicated higher risks for plate complications in cases of malignancy (OR 9.04) and surgical site infection (OR 9.22).

Conclusions:

• CAD-created PSPs demonstrate long-term stability in the majority of patients undergoing fibula free flap mandibular reconstruction.
• The rate of plate removal appears to be lower when compared to reconstructions using non-patient-specific plates.
• Careful consideration of the soft tissue coverage over the plate and proactive management of perioperative infections are crucial for minimizing complications.