title: Microvascular flap reconstruction of the mandible: a comparison of bone grafts and bridging plates for restoration of mandibular continuity.
abstract: OBJECTIVE
  To compare the efficacy of vascularized bone grafts and bridging mandibular reconstruction plates for restoration of mandibular continuity in patients who undergo free flap reconstruction after segmental mandibulectomy. Study design and setting A total of 210 patients underwent microvascular flap reconstruction after segmental mandibulectomy. The rate of successful restoration of mandibular continuity in 151 patients with vascularized bone grafts was compared to 59 patients with soft tissue free flaps combined with bridging plates.
  
  
  RESULTS
  Mandibular continuity was restored successfully for the duration of the follow-up period in 94% of patients who received bone grafts compared with 92% of patients with bridging mandibular reconstruction plates. This difference was not statistically significant. In patients who received bone grafts, most cases of reconstructive failure occurred during the perioperative period and were due to patient death or free flap thrombosis. In patients who received bridging plates, all instances of reconstructive failure were delayed for several months and were due to hardware extrusion or plate fracture.
  
  
  CONCLUSIONS
  Vascularized bone-containing free flaps are preferred for reconstruction of most segmental mandibulectomy defects in patients undergoing microvascular flap reconstruction. However, use of a soft tissue flap with a bridging mandibular reconstruction plate is a reasonable alternative in patients with lateral oromandibular defects when the nature of the defect favors use of a soft tissue free flap.
  
  
  CONCLUSIONS
  Both bone grafts and bridging plates represent effective methods of restoring mandibular continuity following segmental mandibulectomy, with the former being the preferred technique for patients undergoing microvascular reconstruction.
authors.affiliation: Department of Surgery, University of California--Los Angeles, School of Medicine, USA.
authors.forename: Christian
authors.initials: C
authors.lastname: Head
authors.forename: Daniel
authors.initials: D
authors.lastname: Alam
authors.forename: Joel A
authors.initials: JA
authors.lastname: Sercarz
authors.forename: Jivianne T
authors.initials: JT
authors.lastname: Lee
authors.forename: Jeffrey D
authors.initials: JD
authors.lastname: Rawnsley
authors.forename: Gerald S
authors.initials: GS
authors.lastname: Berke
authors.forename: Keith E
authors.initials: KE
authors.lastname: Blackwell
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001860:Bone Plates; D016025:Bone Transplantation / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008337:Mandibular Fractures / Q000601:surgery*; D008339:Mandibular Neoplasms / Q000601:surgery*; D008875:Middle Aged; D019647:Oral Surgical Procedures / Q000379:methods*; D019651:Plastic Surgery Procedures / Q000379:methods*; D013524:Surgical Flaps