THE FREE-FLAP AND PLATE IN OROMANDIBULAR RECONSTRUCTION - LONG-TERM REVIEW AND INDICATIONS

The purpose of this study was to define the role of reconstruction pla tes as bone replacement in oromandibular reconstruction. From 1987 thr ough 1991, 71 consecutive oral cancer patients underwent composite res ection and reconstruction and were entered into one of two studies. In the first study of 31 patients, 15 underwent oromandibular reconstruc tion using a radial forearm osteocutaneous flap, while the remainder ( 16) received a radial forearm fasciocutaneous flap together with a man dibular reconstruction plate. The second study involved 40 subsequent patients, all receiving the latter form of reconstruction. Twenty-one of the plates were stainless steel, and the remaining 19 were of the t itanium hollow screw (THORP) type. We followed the patients prospectiv ely. We defined success as a reconstruction that we did not have to re move. Additionally, since the patients had Limited life expectancy, we developed the idea of days of life lost and incorporated it into our definition of a successful outcome. Vascularized autogenous bone prove d to be more successful than metallic plates used alone in terms both of reconstruction survival and of minimizing days of life lost. The ov erall success rate of mandibular plate reconstruction was 78.9 percent , but analysis by defect type revealed a failure rate of 35 percent wh en the defects were anterior and only 5 percent when they were lateral . THORP plates demonstrated a trend towards more durability. We would now recommend plate reconstruction only in lateral defects in patients with a poor prognosis.