Risk of Plate Exposure in Vascularized Fibula Flap for Mandibular Reconstruction in Primary Oral Cancers

Abstract

Background

To investigate the risk factors for plate exposure in primary oral cancer patients with mandibular defects undergoing tumor ablation followed by vascularized free fibular flap (FFF) transfer, we conducted a retrospective observational study in a single institution in Taiwan.

Methods

The study was performed on a total of 292 primary oral cancer patients who underwent FFF reconstruction between 2015 and 2019. A variety of clinicopathological, surgical, and postoperative parameters were identified and assessed. The data were statistically analyzed with univariate and multivariate logistic regression, and the probability of plate exposure-free rate was plotted as Kaplan-Meier survival curve.

Results

The overall plate exposure rate was 28.76%. The re-exploration group had a higher rate of plate exposure than patients without re-exploration (12.2% vs. 5%, p < 0.05). The 3-year probability of plate exposure-free rates in patients with (n = 216) and without (n = 76) postoperative radiotherapy were 65.9 and 92.5%, and in patients with (n = 141) and without (n = 151) postoperative wound infection were 55.3 and 91.2%, respectively. The multivariate logistic regression showed postoperative radiotherapy and wound infection were independent risk factors for developing plate exposure (adjusted odds ratio [95% CI]: 3.73 [1.37–10.68] and 10.71 [5.15–22.26], p = 0.01 and p <0.001, respectively). More patients required surgical intervention to manage the exposure of hardware.

Conclusion

Our study has highlighted that postoperative radiotherapy and postoperative wound infection are independent risk factors for plate exposure.

Keywords

plate exposure - mandible reconstruction - fibula flap - oral squamous cell carcinoma (OSCC)

Author Contributions

All authors had full access to the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis. Conceptualization, HKK and CKT; Data curation, HKK and CKT; Formal Analysis, ACYC; Investigation, HKK, CKT, CYYL, and SYH; Methodology, HKK and CKT; Resources, HKK, CKT, and SYH; Software, SPSS 22 and GraphPad Prism 10; Supervision, HKK; Visualization, ACYC; Writing—Original Draft, AAP and ACYC; Writing—Review & Editing, AAP, HKK, CYYL, and SYH.

Author Disclosure and Ghostwriting Statement

The authors have no financial interests to disclose. The content of this article was thoroughly written by the authors listed. No ghostwriters were used to write this article.

Data Availability Statement

All data generated or analyzed in this study are included in this published article. The datasets used and/or analyzed during the current study are available from the corresponding author.

^* Drs. Ashwin Alke Pai and Angela Chien-Yu Chen contributed equally to this work.

This study was presented as part of Thesis requirement for MSc in Microsurgery by the First Author Dr Ashwin Alke Pai and the abstract has also been presented in the 33rd EURAPS Annual Meeting in Sweden, May 2023.

Publication History

Received: 06 June 2024

Accepted: 26 January 2025

Accepted Manuscript online:
17 February 2025

Article published online:
07 March 2025

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