Fixation of the vascularized bone graft in mandibular reconstruction.

One hundred and forty vascularized bone grafts were used for mandibular reconstruction in 135 patients. Most followed surgical ablation of squamous carcinoma recurring (or persisting) after irradiation. This paper analyzes the fixation techniques and their effects on bony union. Of 140 vascularized bone grafts, 132 survived and were reviewed. Fifty were stabilized using rigid techniques and 82 by interosseous wires. Rigid fixation had a success rate of 94 percent, while nonrigid techniques resulted in bony union in 96.3 percent. The three failed cases of rigid fixation occurred when short mandibular compression plates were used in iliac crest grafts. We conclude that vascularized bone grafts exhibit a high degree of bony union and that fixation technique--rigid versus nonrigid--appears unimportant in this context. Compression plating is clearly bone-dependent. Nevertheless, use of the reconstruction plate simplifies mandibular reconstruction, and the extra hardware does not appear to increase infection or other soft-tissue complications.