Performance of different osteosynthesis materials in microvascular fibula free flap reconstruction

Purpose Fibula free flap (FFF) is the main reconstructive choice for large mandibular defects. Recent improvements were made regarding planning and surgical procedure, but choice of osteosynthesis material (OSM) for segment-fixation remains controversial. Materials and methods A retrospective cohort study obtained clinical and radiological data from FFF-patients. Data was screened for OSM, surgical procedure and complications as OSM fractures, loosening, exposure, or insufficient osseous consolidation. Results 80 patients with FFF were included. Planning was CAD/CAM (n=29), Recon Guide (n=26) or without planning (n=25). OSM was 2.0mm-miniplates in standard (n=26), preformed (n=6), CAD/CAM (n=14) or ReconGuide (n=23) variation and 2.3mm-reconstruction-plates in standard (n=5) or CAD/CAM (n=6) variation. Complications were observed in 21 cases, fractures in 10 times overall, but with low rates for preformed (n=1), ReconGuide (n=3) and none for CAD/CAM. Analysis detected significant correlations between used OSM and plate exposure (p = .000), but none regarding fracture (p = .275), loosening (p = .714) or insufficient osseous consolidation (p = .208). No correlations were observed between complications and OSM (p = .609) or diagnosis (p = .716). Conclusion Fixation of FFF segments for reconstruction is possible with various OSM providing good clinical outcome. No significant differences were detected regarding prevention of complications by any osteosynthesis material (miniplate vs. macroplate). Although no differences were detected, miniplate usage is advocated whenever clinically reasonable, due to more facile reintervention possibilities and reduced implanted foreign material. Nevertheless, decision for ideal OSM must remain patient-specific and cannot be generalized.