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Designing CAD/CAM Surgical Guides for Maxillary Reconstruction Using an In-house Approach

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Early Complications in Mandibular Reconstruction: Analysis Using Comprehensive Complication Index.

Takeaki Hidaka¹, Shimpei Miyamoto², Yutaka Fukunaga³

¹Department of Plastic and Reconstructive Surgery, National Cancer Center Hospital East, Kashiwa, Japan.

Journal of Surgical Oncology

|April 17, 2026

Summary

This study found no significant difference in early complications among three mandibular reconstruction techniques. Patient factors like diabetes, not surgical method, influenced complication risk, emphasizing careful patient selection for better outcomes.

Keywords:

Clavien‐Dindo classification Comprehensive Complication Index mandibular reconstruction mandibular reconstruction plate vascularized bone flap

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Area of Science:

Oral and Maxillofacial Surgery
Surgical Oncology
Reconstructive Surgery

Background:

Early postoperative complications significantly affect outcomes in advanced oral cancer patients undergoing microvascular mandibular reconstruction.
Three common reconstruction techniques were evaluated: vascularized bone graft (VBG), mandibular reconstruction plate (MRP) with a non-osseous flap, and soft tissue flap (STF).
The Comprehensive Complication Index (CCI) was utilized to assess complication severity.

Purpose of the Study:

To compare the early postoperative complication rates among VBG, MRP, and STF techniques in microvascular mandibular reconstruction.
To identify factors influencing complication risk in patients with advanced oral cancer.

Main Methods:

A retrospective study involving 101 patients undergoing microvascular mandibular reconstruction.
Early postoperative complications (within 30 days) were assessed using the CCI, derived from Clavien-Dindo classification.
Multivariable linear regression was employed to analyze differences in CCI among the three reconstruction techniques.

Main Results:

Vascularized bone graft (VBG) was more frequently performed in younger, healthier patients.
No statistically significant differences in the Comprehensive Complication Index (CCI) were observed among the VBG, MRP, and STF techniques.
Multivariable analysis indicated that non-surgical factors, such as diabetes, were more influential on complication risk than the reconstruction technique.

Conclusions:

Appropriate patient selection is crucial for minimizing early complication risks in microvascular mandibular reconstruction.
Vascularized bone graft (VBG) in younger patients and technical advancements in mandibular reconstruction plate (MRP) techniques may achieve complication burdens comparable to soft tissue flap (STF) reconstruction.