Fibula free flap in maxillomandibular reconstruction. Factors related to osteosynthesis plates’ complications
| Autor: | Alba Sanjuan, Alberto Redondo-Camacho, Francisco Alamillos, Susana Heredero, Alicia Dean, Ipek Guler |
|---|---|
| Rok vydání: | 2020 |
| Předmět: |
medicine.medical_specialty
Mandible Free flap Free Tissue Flaps Fracture Fixation Internal 03 medical and health sciences 0302 clinical medicine Humans Medicine Fibula Retrospective Studies Univariate analysis Bone Transplantation Osteosynthesis business.industry Incidence (epidemiology) 030206 dentistry Surgery Multivariate logistic regression model Mandibular Neoplasms Otorhinolaryngology 030220 oncology & carcinogenesis Radiological weapon Mandibular Reconstruction Oral Surgery business Bone Plates Case series |
| Zdroj: | Journal of Cranio-Maxillofacial Surgery. 48:994-1003 |
| ISSN: | 1010-5182 |
| DOI: | 10.1016/j.jcms.2020.08.003 |
| Popis: | Summary and Keywords Objective The aim of this paper is to identify risk factors associated with the development of osteosynthesis plates´ related complications in fibula free flap reconstructions. Methods This is a case series study of consecutive fibula free flaps. Clinical and radiological variables were recorded. Patient outcomes were evaluated with special attention to osteosynthesis plates´ related complications; these included plate exposure, plate fracture, loosening of screws, non-union, bone resorption, oro-cutaneous fistulas, and bone exposure. We have done a descriptive analysis, univariate analysis, and multivariate logistic regression model to explore possible risk factors for osteosynthesis plates´ related complications. Data analysis was performed using R software (version 3.5.0). Results 111 fibula free flaps were studied. 29 patients (26.1%) developed osteosynthesis plates´ related complications. The mean time to osteosynthesis plates´ related complications was 22 months; range (1-120); the median and mode were 12 months. Patients with preoperative radiotherapy (34% vs 14%, p=0.021), and secondary reconstruction (31% vs 15%, p=0.053) had a higher incidence of osteosynthesis plates´ related complications. In the univariate analysis, “preoperative radiotherapy” (OR 3.07, 95%CI=1.139-8.242, p=0.025) and “extraoral soft-tissue defect” (OR 2.907, 95%CI=1.032-8.088, p=0.042) were risk factors for osteosynthesis plates´ related complications. We have observed an interaction effect: patients with mandibular Brown´s classes III+IV and “secondary reconstruction” have a higher risk for osteosynthesis plates´ related complications; more than 47.30 times compared to Brown´s class I and “primary reconstruction” (p=0.026). Conclusions Different factors may contribute to the development of osteosynthesis plates´ related complications. Our study adds important information about these. Patients with higher risk of developing complications should be informed that a second intervention to remove the plates might be necessary. |
| Databáze: | OpenAIRE |
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