J Reconstr Microsurg 2006; 22 - A092
DOI: 10.1055/s-2006-947970

Application of Internal Fixation and Principles for the Stabilization of Vascularized Bone in Head and Neck Reconstruction: A 15-Year Experience

Alberto Bedogni 1, Olindo Procopio 1, Micro Ragazzo 1, Giorgia Saia 1, Giuseppe M Ferronato 1, Pier Francesco Noccini 1
  • 1Maxillofacial Surgery Units, University Hospital of Padua and Hospital G.B Rossi, University of Verona, Italy

Primary or delayed reconstruction of extensive jawbone defects with vascularized bone is the standard treatment when vascular insufficiency of the recipient area coexists. Stable internal fixation of vascularized bone segments is crucial to achieve prompt bone healing and to hasten functional rehabilitation.

Shaping and fixation of the vascularized bone allow for precise fitting of the defect and provide very reasonable asthetic and functional results.

Different load–bearing and load–sharing fixation systems have been developed and evolved during the last two decades. Traditional load–bearing systems applied to mandibular reconstruction offer the advantage of rigid fixation and allow for masticatory load early and safely. However, they are heavy systems that can compress the periosteum and reduce the vascularization of bone segments. Furthermore, plate removal is often necessary and requires an additional surgical procedure under general anesthesia.

In recent years, new load–bearing systems have been developed, which are much lighter than the former ones, easy to shap, and do not compress the bone.

Load–sharing systems (micro and mini plates and screws) have also been developed and extensively used in reconstructive surgery of the head and neck. These systems share the load–bearing with the bone, and they do not allow for early mastication until complete bone union has been achieved. Temporary intermaxillary fixation has to be added in some cases to ensure adequate stability during the healing phase. However, mini and micro plates are easy to handle and to insert, as well as to remove, if necessary. Number and size of the plates and screws used to fix the bone segments depend largely on the defect size and location.

The authors presented their current protocol of internal fixation of vascularized bone based on a 15-year experience in jaw reconstruction and more than 100 free bone flaps.