Hardware Exposure After Mandibular Reconstruction: Bone Versus Soft Tissue Free Flap Comparison.

Area of Science:

• Oral and Maxillofacial Surgery
• Plastic and Reconstructive Surgery
• Biomaterials Science

Background:

• Hardware exposure is a significant complication following microvascular free tissue transfer (MFTT) for mandibular reconstruction.
• Osteocutaneous MFTTs are preferred, but soft tissue-only MFTTs are used when necessary.
• Limited data exists comparing hardware exposure risk between these MFTT approaches.

Purpose of the Study:

• To compare the rate and timing of hardware exposure between osteocutaneous and soft tissue MFTTs for mandibular reconstruction.
• To identify factors influencing hardware exposure risk in patients undergoing MFTT.

Main Methods:

• Retrospective review of 178 patients undergoing MFTT for mandibular defects (11/2011-6/2023).
• Primary exposure: flap type (osteocutaneous vs. soft tissue).
• Primary outcome: time to hardware exposure; secondary outcome: exposure rate at 1 and 3 years.

Main Results:

• No significant difference in hardware exposure timing between osteocutaneous and soft tissue MFTTs at 1 or 3 years.
• Adjuvant radiation and/or chemoradiation significantly increased the hazard of hardware exposure at 1 year (HR 7.72) and 3 years (HR 3.68).
• Exposure rates increased by approximately 10% from 1 to 3 years postoperatively for both flap types.

Conclusions:

• Flap type (osteocutaneous vs. soft tissue) is not associated with differences in hardware exposure timing after MFTT for mandibular reconstruction.
• Adjuvant therapy is a significant risk factor for hardware exposure.
• Surgeons should consider the increased risk of exposure in patients receiving adjuvant therapy.