Comparison of miniplates and reconstruction plates in fibular flap reconstruction of the mandible

BACKGROUND: Mandibular reconstruction using free fibular flaps can be performed using various plating techniques. Miniplates (≤2.0 mm) and reconstruction plates (>2.0 mm) have different characteristics that provide theoretical advantages and disadvantages with regard to successful neomandibular fixation. METHODS: A retrospective review of 117 patients undergoing free fibular reconstruction of segmental mandibular defects over the past 10 years was performed. Characteristic data and complication rates were recorded; the authors compared patients who had fibular reconstruction of their mandibular defect with miniplates (n = 86) with those who underwent repair using reconstruction plates (n = 31). RESULTS: No statistically significant difference was identified when comparing miniplates and reconstruction plates with regard to overall cumulative complication rates (46 versus 48 percent), flap failure (15 percent versus 27 percent), plate extrusion (23 percent versus 25 percent), malunion or nonunion (14 percent versus 13 percent), and plate fracture (10 percent versus 0 percent). (The cumulative percentage incidence weighs patient data according to length of follow-up.) The authors' data did suggest a decreased incidence of osteonecrosis in the miniplate group (5 percent versus 38 percent; p = 0.02), but these results must be interpreted cautiously because of the small sample size. CONCLUSION: Selection of plate size, miniplate versus reconstruction plate, does not appear to affect the overall rate of complications in free fibular reconstruction of the mandible.