title: Hardware removal after osseous free flap reconstruction.
abstract: OBJECTIVE
  Identifying risk factors for hardware removal in patients undergoing mandibular reconstruction with vascularized osseous free flaps remains a challenge. The purpose of this study is to identify potential risk factors, including osteocutaneous radial forearm versus fibular flap, for need for removal and to describe the fate of implanted hardware.
  
  
  METHODS
  Case series with chart review Setting Academic tertiary care medical center.
  
  
  METHODS
  Two hundred thirteen patients undergoing 227 vascularized osseous mandibular reconstructions between the years 2004 and 2012. Data were compiled through a manual chart review, and patients incurring hardware removals were identified.
  
  
  RESULTS
  Thirty-four of 213 evaluable vascularized osseous free flaps (16%) underwent surgical removal of hardware. The average length of time to removal was 16.2 months (median 10 months), with the majority of removals occurring within the first year. Osteocutaneous radial forearm free flaps (OCRFFF) incurred a slightly higher percentage of hardware removals (9.9%) compared to fibula flaps (6.1%). Partial removal was performed in 8 of 34 cases, and approximately 38% of these required additional surgery for removal.
  
  
  CONCLUSIONS
  Hardware removal was associated with continued tobacco use after mandibular reconstruction (P = .03). Removal of the supporting hardware most commonly occurs from infection or exposure in the first year. In the majority of cases the bone is well healed and the problem resolves with removal.
authors.affiliation: Department of Surgery, Division of Otolaryngology, University of Alabama at Birmingham, Birmingham, Alabama, USA.
authors.forename: Kristine E
authors.initials: KE
authors.lastname: Day
authors.forename: Renee
authors.initials: R
authors.lastname: Desmond
authors.forename: J Scott
authors.initials: JS
authors.lastname: Magnuson
authors.forename: William R
authors.initials: WR
authors.lastname: Carroll
authors.forename: Eben L
authors.initials: EL
authors.lastname: Rosenthal
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016025:Bone Transplantation; D020878:Device Removal / Q000379:methods*; D005260:Female; D005360:Fibula; D058752:Free Tissue Flaps; D006801:Humans; D008297:Male; D008334:Mandible / Q000601:surgery*; D008875:Middle Aged; D011183:Postoperative Complications / Q000601:surgery; D011884:Radius; D019651:Plastic Surgery Procedures; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors
keywords: hardware removal; mandible; osseous free flap; reconstruction