Abstract：
OBJECTIVE: Assess the long-term plate complications with patient-specific plates (PSPs) created with computer-aided design (CAD) and computer-aided manufacturing (CAM) for fibula free flap reconstructions for mandibular defects.
METHODS: Retrospective chart review from January 2010 to July 2022 of patients who underwent mandibular reconstruction with a fibula free flap and PSP. Primary outcome was plating-related complications, defined as plate exposure, fracture, loose screws, and plate removal.
RESULTS: A total of 221 patients underwent PSP fibula reconstruction. Average age was 59.8 + 14.3 years old with male to female ratio of 2:1. Squamous cell carcinoma of the mandible was the most common reason for resection, 47.5%, n = 105. Plate removal occurred in 11% of patients (n = 25) about 17.4 months after the initial surgery. Plates were removed due to exposure (76%, n = 19) or screw loosening (24%, n = 6). Malignancy was associated with an increased risk of plate complications when compared to benign tumor (odds ratio [OR] 9.04, confidence interval [CI] 1.36-3.85), osteonecrosis (OR 1.38, CI 0.59-3.48), and trauma (OR 1.26, CI 0.23-12.8). Postoperative radiation therapy (OR 2.27, CI 1.07-4.82, p = 0.026) and surgical site infection (OR 9.22, CI 4.11-21.88, p = 0.001) were associated with more plate complications.
CONCLUSIONS: CAD creates PSPs that remain stable in the majority of patients over the long term. Plate removal is less compared to non-PSP reconstruction. Consideration of the soft tissue envelope over the plate and management of perioperative infection at the time of surgery should be entertained.
METHODS: Level 4 Laryngoscope, 2024.
METHODS: Retrospective chart review from January 2010 to July 2022 of patients who underwent mandibular reconstruction with a fibula free flap and PSP. Primary outcome was plating-related complications, defined as plate exposure, fracture, loose screws, and plate removal.
RESULTS: A total of 221 patients underwent PSP fibula reconstruction. Average age was 59.8 + 14.3 years old with male to female ratio of 2:1. Squamous cell carcinoma of the mandible was the most common reason for resection, 47.5%, n = 105. Plate removal occurred in 11% of patients (n = 25) about 17.4 months after the initial surgery. Plates were removed due to exposure (76%, n = 19) or screw loosening (24%, n = 6). Malignancy was associated with an increased risk of plate complications when compared to benign tumor (odds ratio [OR] 9.04, confidence interval [CI] 1.36-3.85), osteonecrosis (OR 1.38, CI 0.59-3.48), and trauma (OR 1.26, CI 0.23-12.8). Postoperative radiation therapy (OR 2.27, CI 1.07-4.82, p = 0.026) and surgical site infection (OR 9.22, CI 4.11-21.88, p = 0.001) were associated with more plate complications.
CONCLUSIONS: CAD creates PSPs that remain stable in the majority of patients over the long term. Plate removal is less compared to non-PSP reconstruction. Consideration of the soft tissue envelope over the plate and management of perioperative infection at the time of surgery should be entertained.
METHODS: Level 4 Laryngoscope, 2024.
摘要：
目的：使用计算机辅助设计（CAD）和计算机辅助制造（CAM）创建的患者专用钢板（PSP）评估下颌骨缺损无腓骨皮瓣重建的长期钢板并发症。
方法：回顾性分析2010年1月至2022年7月接受腓骨游离皮瓣和PSP下颌骨重建的患者的图表。主要结果是电镀相关并发症，定义为平板暴露，骨折,螺钉松动,和板移除。
结果：共有221例患者接受了PSP腓骨重建。平均年龄为59.8±14.3岁,男女比例为2:1。下颌骨鳞状细胞癌是最常见的切除原因，47.5%,n=105。最初手术后约17.4个月，11％的患者（n=25）发生了钢板切除。板由于暴露而被移除(76%，n=19)或螺钉松动(24%,n=6)。与良性肿瘤相比，恶性肿瘤与钢板并发症的风险增加相关（比值比[OR]9.04，置信区间[CI]1.36-3.85），骨坏死（OR1.38，CI0.59-3.48），和创伤（OR1.26，CI0.23-12.8）。术后放疗（OR2.27，CI1.07-4.82，p=0.026）和手术部位感染（OR9.22，CI4.11-21.88，p=0.001）与更多的钢板并发症相关。
结论：CAD产生的PSP在大多数患者中长期保持稳定。与非PSP重建相比，板的去除较少。应考虑钢板上的软组织包膜和手术时的围手术期感染处理。
方法：4级喉镜，2024.
方法：回顾性分析2010年1月至2022年7月接受腓骨游离皮瓣和PSP下颌骨重建的患者的图表。主要结果是电镀相关并发症，定义为平板暴露，骨折,螺钉松动,和板移除。
结果：共有221例患者接受了PSP腓骨重建。平均年龄为59.8±14.3岁,男女比例为2:1。下颌骨鳞状细胞癌是最常见的切除原因，47.5%,n=105。最初手术后约17.4个月，11％的患者（n=25）发生了钢板切除。板由于暴露而被移除(76%，n=19)或螺钉松动(24%,n=6)。与良性肿瘤相比，恶性肿瘤与钢板并发症的风险增加相关（比值比[OR]9.04，置信区间[CI]1.36-3.85），骨坏死（OR1.38，CI0.59-3.48），和创伤（OR1.26，CI0.23-12.8）。术后放疗（OR2.27，CI1.07-4.82，p=0.026）和手术部位感染（OR9.22，CI4.11-21.88，p=0.001）与更多的钢板并发症相关。
结论：CAD产生的PSP在大多数患者中长期保持稳定。与非PSP重建相比，板的去除较少。应考虑钢板上的软组织包膜和手术时的围手术期感染处理。
方法：4级喉镜，2024.
