title: How we fix free flaps to the bone in oral and oropharyngeal reconstructions.
abstract: OBJECTIVE
  The use of suture anchors has been described in orthopedic, hand, oculoplastic, temporomandibular joint and in aesthetic surgery, but no study reports the use of the Mitek® anchors (Depuy Mitek Surgical Products, Inc. Raynham, Massachusetts) for fixing the free flaps used in oncologic oral and oropharyngeal reconstruction.
  
  
  METHODS
  In this prospective non-randomized study, 9 patients underwent surgical resection of oral or oropharyngeal cancer followed by a free flap reconstruction; mini anchors were used to fix the flap directly to the bone. We collected data regarding the patients, the tumor stage, the surgical procedure, the radiotherapy and the number of anchors used.
  
  
  RESULTS
  The average follow-up was 28months (range 24-38).We observed no complications with trans-oral, sub-mandibular and trans-mandibular approach in both oral and oropharyngeal reconstructions. All anchors became osteo-integrated and no complications occurred after radiotherapy.
  
  
  CONCLUSIONS
  In our opinion this device favors free flap adhesion to the bone. We registered no postoperative complications related to the use of the device which looks suitable for use in irradiated tissues. The radiotherapy did not cause any long-term complications related to the use of Mitek® mini bone anchors.
authors.affiliation: Department of Plastic and Reconstructive Surgery, Cattinara Hospital, University of Trieste, Strada di Fiume 447, I-34149,Trieste, Italy.
authors.forename: Zoran Marij
authors.initials: ZM
authors.lastname: Arnež
authors.affiliation: Department of Plastic and Reconstructive Surgery, Cattinara Hospital, University of Trieste, Strada di Fiume 447, I-34149,Trieste, Italy.
authors.forename: Federico Cesare
authors.initials: FC
authors.lastname: Novati
authors.affiliation: Department of Plastic and Reconstructive Surgery, Cattinara Hospital, University of Trieste, Strada di Fiume 447, I-34149,Trieste, Italy.
authors.forename: Vittorio
authors.initials: V
authors.lastname: Ramella
authors.affiliation: Department of Plastic and Reconstructive Surgery, Cattinara Hospital, University of Trieste, Strada di Fiume 447, I-34149,Trieste, Italy.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Papa
authors.affiliation: Division of Oral Medicine, Department of Dental Sciences, Piazza dell'Ospitale 1, University of Trieste, Trieste, Italy.
authors.forename: Matteo
authors.initials: M
authors.lastname: Biasotto
authors.affiliation: Department of Otorhinolaryngology and Head and Neck Surgery, Cattinara Hospital, University of Trieste, Strada di Fiume 447, I-34149,Trieste, Italy.
authors.forename: Annalisa
authors.initials: A
authors.lastname: Gatto
authors.affiliation: Department of Otorhinolaryngology and Head and Neck Surgery, Cattinara Hospital, University of Trieste, Strada di Fiume 447, I-34149,Trieste, Italy.
authors.forename: Pierluigi
authors.initials: P
authors.lastname: Bonini
authors.affiliation: Department of Otorhinolaryngology and Head and Neck Surgery, Cattinara Hospital, University of Trieste, Strada di Fiume 447, I-34149,Trieste, Italy. Electronic address: margheritatofanelli@hotmail.com.
authors.forename: Margherita
authors.initials: M
authors.lastname: Tofanelli
authors.affiliation: Department of Otorhinolaryngology and Head and Neck Surgery, Cattinara Hospital, University of Trieste, Strada di Fiume 447, I-34149,Trieste, Italy.
authors.forename: Giancarlo
authors.initials: G
authors.lastname: Tirelli
mesh_terms: D000368:Aged; D005260:Female; D005500:Follow-Up Studies; D058752:Free Tissue Flaps / Q000098:blood supply / Q000637:transplantation*; D006084:Graft Rejection; D006085:Graft Survival; D006801:Humans; D008297:Male; D008334:Mandible / Q000601:surgery; D008875:Middle Aged; D009062:Mouth Neoplasms / Q000473:pathology / Q000601:surgery*; D009361:Neoplasm Invasiveness / Q000473:pathology; D009367:Neoplasm Staging; D009959:Oropharyngeal Neoplasms / Q000473:pathology / Q000601:surgery*; D011446:Prospective Studies; D019651:Plastic Surgery Procedures / Q000009:adverse effects / Q000379:methods*; D018570:Risk Assessment; D053441:Suture Anchors; D013997:Time Factors; D016896:Treatment Outcome