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Treatment of Ankle Osteoarthritis with Total Ankle Replacement Through a Lateral Transfibular Approach

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Risks of Miniplate Removal in Fibula Free Flap Oromandibular Reconstruction.

Kuo-Chung Yang^1,2, Wen-Chung Liu^1,2,3,4

¹Department of Surgery, Division of Plastic and Reconstructive Surgery Kaohsiung Veterans General Hospital Kaohsiung Taiwan (R.O.C.).

|March 5, 2026

Summary

Radiotherapy and multiple osteotomies increase the risk of miniplate removal after fibula free flap (FFF) reconstruction. Irradiated patients face the highest risk within 30 months, requiring careful surgical planning and monitoring.

Keywords:

free fibula flap miniplate removal oromandibular reconstruction osteotomies radiotherapy surgical complications

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Area of Science:

Oral and Maxillofacial Surgery
Reconstructive Surgery
Biomaterials in Surgery

Background:

Miniplate removal is a potential complication following oromandibular reconstruction using fibula free flaps (FFF).
Identifying risk factors is crucial for improving patient outcomes and reducing revision surgeries.

Purpose of the Study:

To determine clinical and surgical risk factors associated with miniplate removal after FFF oromandibular reconstruction.
To evaluate the temporal pattern of miniplate removal complications.

Main Methods:

Retrospective cohort study of 184 patients undergoing oromandibular reconstruction with FFF.
Analysis of miniplate removal incidence and associated postoperative complications.
Multivariate logistic regression and Kaplan-Meier analysis to identify risk factors and timing.

Main Results:

Miniplate removal was required in 16.3% of patients (30/184).
Higher rates of abscess/fistula, osteomyelitis, and osteoradionecrosis were observed in patients requiring miniplate removal.
Preoperative/postoperative radiotherapy (OR 9.27) and increased osteotomies (OR 3.77) were independent risk factors for removal.

Conclusions:

Radiotherapy and a higher number of osteotomies are significant risk factors for miniplate removal post-FFF reconstruction.
The risk of miniplate removal is elevated in irradiated patients, particularly within the first 30 months.
Tailored surgical strategies and vigilant postoperative monitoring are essential for patients undergoing FFF reconstruction, especially those who have received radiotherapy.