Miniplates Versus Reconstruction Bars for Oncologic Free Fibula Flap Mandible Reconstruction

Purpose: The free fibula is the flap of choice for reconstructing most segmental mandibular defects resulting from head and neck resections. The use of miniplates or reconstruction bars for fixation has been described in the literature. We wanted to compare outcomes between the 2 methods of fixation in head and neck cancer patients. Patients and Methods: An IRB approved retrospective review of 25 consecutive patients undergoing free fibula flap reconstruction of the mandible for head and neck cancer over a period of 5 years was performed. Patient demographics, risk factors, number of fibula osteotomies, defect length, and clinical outcomes were noted. Fourteen patients were reconstructed with miniplates and 12 with reconstruction bars. The choice of plate fixation was determined by the individual reconstructive surgeon. Wound complications requiring surgery and hardware removal rate were recorded. Results: Average follow-up was 27 months. There was no significant difference with regard to age (P = 0.67), sex (P = 0.77), smoking (P = 0.63), neoadjuvant radiation (P = 0.47), number of osteotomies (P = 0.99), or defect length (P = 0.95) between the 2 groups. Of the 4 patients requiring hardware removal for infection or persistent symptoms, all were in the miniplate group (P = 0.05). Other clinical outcomes, such as hematoma, wound dehiscence, infection, fistula formation, and osteoradionecrosis were comparable between the 2 groups without significant differences. The overall complication rate was similar as well (P = 0.25). Discussion: Different from other reports in the literature, we show that miniplate use resulted in more hardware removal for infection or persistent symptoms, and this was statistically significant while controlling for patient demographics, risk factors, number of osteotomies, and defect length. Much like other reports in the literature, however, there is no statistically significant difference in overall complication rates, and all other specific complications, when using miniplates versus reconstruction bars. The decision to use miniplates versus reconstruction bars remains a clinical one. In our experience, for 0 to 1 osteotomy, a reconstruction bar suffices. For multiple osteotomies, however, miniplates allow for more customization.