Department of Surgery, Division of Otolaryngology, University of Alabama at Birmingham, Birmingham, Alabama, USA.
Otolaryngol Head Neck Surg. 2014 Jan;150(1):40-6. doi: 10.1177/0194599813512103. Epub 2013 Nov 7.
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.
Case series with chart review Setting Academic tertiary care medical center.
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.
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.
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.
确定接受血管化骨游离皮瓣下颌骨重建患者需要移除硬件的风险因素仍然是一个挑战。本研究旨在确定潜在的风险因素，包括骨皮桡骨前臂与腓骨瓣，以确定需要移除的因素，并描述植入硬件的命运。
病例系列与图表回顾 学术三级护理医疗中心。
2004 年至 2012 年间，213 例患者接受了 227 例血管化骨下颌骨重建。通过手动图表审查收集数据，并确定发生硬件移除的患者。
34 例可评估的血管化骨游离皮瓣（16%）进行了硬件移除手术。平均移除时间为 16.2 个月（中位数为 10 个月），大多数移除发生在第一年。骨皮桡骨前臂游离皮瓣（OCRFFF）的硬件移除率略高于腓骨瓣（9.9%）（6.1%）。在 34 例中有 8 例进行了部分移除，其中约 38%需要进一步手术移除。
下颌骨重建后继续吸烟与硬件移除有关（P =.03）。支撑硬件的移除最常见于感染或暴露在第一年。在大多数情况下，骨骼愈合良好，问题通过移除得到解决。
