title: Plate exposure after anterolateral thigh free-flap reconstruction in head and neck cancer patients with composite mandibular defects.
abstract: BACKGROUND
  This study aimed to identify the risk factors for postoperative plate exposure in head and neck cancer patients with composite mandibular defects undergoing tumor ablation followed by bridging plate and anterolateral thigh (ALT) flap transfer.
  
  
  METHODS
  Between January 2007 and June 2012, 1,452 patients who underwent free tissue transfer after head and neck cancer ablation were retrospectively reviewed. Only ALT flap coverage with a bridging plate for segmental mandibular defects was included. The Jewer's classification was used to define the type of mandibular defect.
  
  
  RESULTS
  The study enrolled 123 men and 7 women. The incidence of plate exposure was 37.7 % (49/130). The follow-up time ranged from 0.5 to 5.4 years (mean, 2.4 years). The 5-year probability of a plate exposure-free rate was 32.8 % for the patients with postoperative radiotherapy (RT) (n = 33) and 64.3 % for the patients without it (n = 97). Patients reconstructed with a fasciocutaneous or chimeric type of ALT flap had higher rates of plate exposure than those reconstructed with a musculocutaneous type of ALT flap (p = 0.002). As shown by logistic regression, the significant predictive risk factors for postoperative plate exposure still were postoperative RT [adjusted odds ratio (OR) 2.76, 95 % confidence interval (CI) 1.09-6.99, p = 0.031] and intraoperative blood loss (adjusted OR 2.37, 95 % CI 1.13-4.99, p = 0.022).
  
  
  CONCLUSIONS
  The type of ALT flap, postoperative RT, and intraoperative blood loss were the predisposing factors for increased risk of postoperative plate exposure in the specific disease group.
authors.affiliation: Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Tao-Yuan, Taiwan.
authors.forename: Paolo Maria
authors.initials: PM
authors.lastname: Fanzio
authors.forename: Kai-Ping
authors.initials: KP
authors.lastname: Chang
authors.forename: Hsin-Hung
authors.initials: HH
authors.lastname: Chen
authors.forename: Hsiang-Hao
authors.initials: HH
authors.lastname: Hsu
authors.forename: Vijay
authors.initials: V
authors.lastname: Gorantla
authors.forename: Mario G
authors.initials: MG
authors.lastname: Solari
authors.forename: Huang-Kai
authors.initials: HK
authors.lastname: Kao
mesh_terms: D001860:Bone Plates; D002294:Carcinoma, Squamous Cell / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006258:Head and Neck Neoplasms / Q000601:surgery*; D006801:Humans; D008297:Male; D008339:Mandibular Neoplasms / Q000601:surgery*; D008875:Middle Aged; D009367:Neoplasm Staging; D011183:Postoperative Complications; D011379:Prognosis; D019651:Plastic Surgery Procedures / Q000009:adverse effects*; D012189:Retrospective Studies; D013524:Surgical Flaps; D013848:Thigh / Q000601:surgery*