Multicenter Comparison of Modern Plating Options in Fibula, Scapula, and Osteocutaneous Radial Forearm Free Flaps

Evaluate the association of plating strategies with hardware removal and operative time, after adjusting for relevant clinical variables.

Retrospective Review.

Multiple Academic Medical Centers.

Patients undergoing osseous free flap reconstruction stratified based on the plating strategy [conventional plating with a hand-bent plate, precontoured plate, and virtual surgical planning (VSP) with patient-specific hardware and cutting guides]. Variables associated with hardware removal were analyzed using multivariable logistic regression. To evaluate the effect of plating strategy on operative time, a multivariable linear regression model was created. Adjusted odds ratios (aOR) with 95% confidence intervals (CI) were calculated.

1022 patients were analyzed: 650 (63.6%) conventional plate, 163 (15.9%) precontoured plate, and 209 (20.5%) VSP. Compared to conventional plating (aOR: 1.00), VSP was independently associated with lower odds of hardware removal (aOR: 0.39, 95% CI: 0.23-0.68), while there was no difference with precontoured plates (aOR: 0.84, 95% CI: 0.52-1.38). Compared to conventional plates, precontoured plates were associated with a reduction in operative time of 31.13 minutes (95% CI: 2.93-59.33), and VSP was associated with a reduction in 76.87 minutes (95% CI: 50.15-103.57), adjusting for flap type and defect length.

This multi-institutional study demonstrates that head and neck osseous reconstruction with customized, patient-specific hardware and VSP is associated with a lower rate of hardware removal and shorter operative time compared to precontoured or hand-bent hardware. Additionally, cases utilizing precontoured hardware were associated with shorter operative time, but similar rates of hardware removal compared to conventional plates.