Soft tissue coverage of mandibular reconstruction plates

Area of Science:

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

Background:

• Mandibular reconstruction plates are crucial for restoring facial structure after composite defects.
• Pectoralis major flaps have been a traditional method for covering these plates.
• Limitations of pectoralis flaps include high rates of hardware exposure and complications.

Purpose of the Study:

• To compare the efficacy and outcomes of free tissue transfer versus pectoralis major flap coverage for mandibular reconstruction plates.
• To evaluate complication rates, operating room time, hospital stay, and secondary procedures for each flap type.

Main Methods:

• A retrospective review of 14 patients undergoing mandibular reconstruction with plates.
• Patients were divided into two groups: pectoralis flap coverage (9 patients) and free tissue transfer (5 patients).
• Data collected included plate extrusion, operating room time, hospital stay, and need for secondary procedures.

Main Results:

• Pectoralis flap group experienced plate extrusion in 44% of cases, versus 0% in the free flap group.
• Free flap group had a longer mean operating room time (721 min vs. 550 min).
• Free flap group demonstrated a significantly shorter hospital stay (20 days vs. 39 days) and fewer secondary procedures (20% vs. 88%).

Conclusions:

• Free tissue transfer provides a more reliable coverage for mandibular reconstruction plates, significantly reducing complications like plate extrusion.
• Despite longer operative times, free flaps result in better overall patient outcomes, including shorter hospitalizations and fewer revision surgeries.
• Free flaps represent a superior reconstructive option for mandibular plates, justifying their increased technical demand.