Mini-Plate Versus Reconstruction Bar Fixation For Oncologic Reconstruction With Free Fibula Flaps: A Single Center Experience
Zack Cohen, MD, Meghana G. Shamsunder, MPH, Francis D. Graziano, MD, Farooq Shahzad, MBBS, FACS, FAAP, Jay O. Boyle, MD, Marc A. Cohen, MD, MPH, Evan Matros, MD, MMSc, MPH, Jonas A. Nelson, MD, MPH, Robert J. Allen, Jr., MD.
Memorial Sloan Kettering Cancer Center, New York, NY, USA.
PurposeThe aim of this study is to examine complication rates between mini plate (MP) and reconstruction bar (RB) fixation of free fibula flaps (FFF) at a tertiary cancer center. We hypothesized that increased hardware as well as a lack of rigid fixation inherent to MPs would lead to higher rates of hardware exposure.
Methods All patients who underwent FFF reconstruction between 2015-2021 were examined. The primary outcomes of interest were perioperative flap-related complications/infections as well as long-term malunion/nonunion, osteoradionecrosis, and hardware exposure. Patients were stratified into 2 groups: short-term complications (<90 days) and long-term complications (>90 days).
ResultsA total of 103 patients were included (RB=65, MP=38). Patients were similar with respect to age, diabetes, CAD/PVD, smoking, and operative characteristics. The mean follow-up period was 17.03 months. Adjuvant radiation was administered to 52.6% and 53.8% of patients in the MP and RB cohorts respectively. Previous head and neck surgery was performed in 23 RB and 13 MP patients. Wound dehiscence was more common with MPs within the first 90 days (2 vs. 6, p=0.048). After 90 days, MPs had significantly higher rates of cellulitis (1 vs. 4, p=0.017) and hardware exposure (0 vs. 3, p=0.022).
ConclusionsMPs have a higher risk of long-term hardware exposure compared to RB fixation. It is possible that improved fixation with highly adaptive RBs offered by computer-aided design technology explains these results. Future studies are needed to assess the effects of fixation on patient reported outcomes and quality of life measures in this population.
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