Evaluation of hardware-related complications in vascularized bone grafts with locking mandibular reconstruction plate fixation.
OBJECTIVE
To identify the incidence of hardware and bone-healing complications in patients who underwent locking mandibular reconstruction plate (LMRP) fixation of vascularized bone grafts for reconstruction of segmental mandibular defects.


METHODS
Case series.


METHODS
Academic tertiary care medical center.


METHODS
One hundred one patients who had undergone LMRP fixation of vascularized bone grafts for reconstruction of segmental mandibular defects with a minimum follow-up of 6 months.


METHODS
Association of patient- and defect-related characteristics with the incidence of loose screws, osteosynthesis nonunion, and complications necessitating hardware removal.


RESULTS
The incidence of loose screws was 0.8% in 984 locking screws implanted. The incidence of nonunion was 0.7% in 290 osteosyntheses. Overall, 15 of 101 LMRPs (14.8%) were removed because of hardware-related complications, with plate extrusion (n = 10) the most common complication necessitating hardware removal. Pathologic diagnosis (P = .002), previous treatment with hyperbaric oxygen (P < .001), radiation therapy (P < .001), and cancer recurrence (P = .03) were statistically significant predictors of LMRP-related complications at univariate analysis. At multivariate analysis, previous treatment with hyperbaric oxygen (P < .046) remained a statistically significant predictor of LMRP-related complications.


CONCLUSIONS
In patients undergoing mandibular reconstruction, LMRPs are highly effective for fixation of vascularized bone grafts, with a high incidence of bone-graft healing and a low incidence of complications related to loose screws. Nevertheless, there remains a 15% incidence of hardware-related complications, most related to hardware extrusion. Previous treatment with hyperbaric oxygen is a statistically significant predictor of LMRP-related complications.
Knott
P Daniel
PD
Division of Head and Neck Surgery, David Geffen School of Medicine, 62-132 CHS, University of California Los Angeles Medical Center, Los Angeles, CA 90095-1624, USA.
Suh
Jeffrey D
JD
Nabili
Vishad
V
Sercarz
Joel A
JA
Head
Christian
C
Abemayor
Elliot
E
Blackwell
Keith E
KE
D001860:Bone Plates; D001863:Bone Screws; D016025:Bone Transplantation / Q000379:methods*; D002140:California / Q000453:epidemiology; D020878:Device Removal; D004868:Equipment Failure; D005260:Female; D005360:Fibula / Q000098:blood supply / Q000637:transplantation*; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D008297:Male; D008334:Mandible / Q000098:blood supply / Q000637:transplantation*; D008339:Mandibular Neoplasms / Q000601:surgery*; D011183:Postoperative Complications / Q000453:epidemiology; D019651:Plastic Surgery Procedures / Q000295:instrumentation*; D012189:Retrospective Studies; D016896:Treatment Outcome