Chang Tzu-Yen, Lai Yen-Shuo, Lin Chung-Ying, Wang Jung-Der, Pan Shin-Chen, Shieh Shyh-Jou, Lee Jing-Wei, Lee Yao-Chou
Division of Plastic and Reconstructive Surgery, Department of Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
Institute of Allied Health Sciences, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
Microsurgery. 2023 Feb;43(2):131-141. doi: 10.1002/micr.30893. Epub 2022 May 12.
Plate-related complications are major long-term complications in mandible reconstruction. There are controversies regarding the use of a reconstruction plate versus miniplates and a bone flap versus a soft tissue flap with a bridging plate. Direct comparisons of a fibula flap and an anterolateral thigh flap, the applicability between a reconstruction plate and miniplate, and the correlation between plate-related complications and quality of life remain unclarified. Therefore, this study aimed to the explore complications of different flaps and plates and how they impact the patients' quality of life.
We retrospectively reviewed the medical records of a total of 205 patients aged >18 years who underwent segmental mandibulectomy and reconstruction using fibula flap with reconstruction plate (FR; n = 86), fibula flap with miniplate (FM; n = 61), and anterolateral thigh flap with reconstruction plate (AR; n = 58) due to cancer ablation, osteoradionecrosis, or benign tumor excision between August 2010 and December 2019. Data on characteristics, complications, and health-related quality of life were collected and analyzed.
The plate-related complication rate was the highest in the AR group (37.9%), then in the FR group (25.6%), and was the lowest in the FM group (13.1%; p = 0.0079). The plate exposure rate was the highest in the AR group (24.1%), then in the FR group (15.7%), and was the lowest in the FM group (4.9%; p = 0.0128). The plate fracture and dislodge rates for the AR group were both higher than those for the FR and FM groups (24.1% versus 9.3% versus 9.8%, respectively; p = 0.023). The AR group had worse complication-free survival (hazard ratio [HR]: 3.61, 95% CI: 1.99-6.56, and p < 0.0001) than the FR and FM groups. Osteoradionecrosis (HR: 6.19, 95% CI: 2.11-18.21, and p = 0.0009) and postoperative radiotherapy (HR: 2.87, 95% CI: 1.34-6.12, and p = 0.0402) were both independent adverse factors for complication-free survival, whereas patient treated primarily (HR: 0.35, 95% CI: 0.17-0.73, and p = 0.0048) was an independent protective factor. Plate-related complication negatively impacted the quality of life based on pain scores (β: -0.56, SE: 0.26, and p = 0.034).
Using a fibular flap fixed with miniplates and avoiding the use of a reconstruction plate may yield a reduced plate exposure rate and better health-related quality of life, particularly for patients with osteoradionecrosis or those who need postoperative radiotherapy.
钢板相关并发症是下颌骨重建的主要长期并发症。关于使用重建钢板与微型钢板，以及骨瓣与带桥接钢板的软组织瓣，存在争议。腓骨瓣和股前外侧皮瓣的直接比较、重建钢板与微型钢板的适用性，以及钢板相关并发症与生活质量之间的相关性仍不明确。因此，本研究旨在探讨不同皮瓣和钢板的并发症，以及它们如何影响患者的生活质量。
我们回顾性分析了2010年8月至2019年12月期间，因癌症切除、放射性骨坏死或良性肿瘤切除，接受节段性下颌骨切除并使用带重建钢板的腓骨瓣（FR；n = 86）、带微型钢板的腓骨瓣（FM；n = 61）和带重建钢板的股前外侧皮瓣（AR；n = 58）进行重建的205例年龄>18岁患者的病历。收集并分析有关特征、并发症和健康相关生活质量的数据。
钢板相关并发症发生率在AR组最高（37.9%），其次是FR组（25.6%），在FM组最低（13.1%；p = 0.0079）。钢板暴露率在AR组最高（24.1%），其次是FR组（15.7%），在FM组最低（4.9%；p = 0.0128）。AR组的钢板骨折和移位率均高于FR组和FM组（分别为24.1%、9.3%和9.8%；p = 0.023）。AR组的无并发症生存率比FR组和FM组差（风险比[HR]：3.61，95%置信区间：1.99 - 6.56，p < 0.0001）。放射性骨坏死（HR：6.19，95%置信区间：2.11 - 18.21，p = 0.0009）和术后放疗（HR：2.87，95%置信区间：1.34 - 6.12，p = 0.0402）均为无并发症生存的独立不利因素，而原发治疗患者（HR：0.35，95%置信区间：0.17 - 0.73，p = 0.0048）是独立保护因素。基于疼痛评分，钢板相关并发症对生活质量有负面影响（β： - 0.56，标准误：0.26，p = 0.034）。
使用微型钢板固定的腓骨瓣并避免使用重建钢板，可能会降低钢板暴露率，并带来更好的健康相关生活质量，特别是对于放射性骨坏死患者或需要术后放疗的患者。
