Rethinking exposed reconstruction plates - our experience

Huston, M, Patel, Nikul ORCID: https://orcid.org/0009-0005-7452-7694, Merrick, G and Al-Rikabi, A 2024. Rethinking exposed reconstruction plates - our experience. Presented at: ICOMS Vancouver 2023, Vancouver, 2023. International Journal of Oral and Maxillofacial Surgery. Elsevier, 10.1016/j.ijom.2023.10.233

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Abstract

Background: The combined use of reconstruction plates alongside bone grafts has enabled preservation of both function and aesthetic following segmental mandibulectomy. However, the approach is not without complication. Reports suggest that up to 45% of cases develop subsequent soft tissue breakdown and plate exposure which presents a challenge for management. Case: We present the novel management of exposed reconstruction plates in a series of two patients who underwent fibular free flap reconstruction surgery. The patients experienced soft tissue breakdown revealing the metal support following radiotherapy. Refining a technique from our orthopedic colleagues, we sectioned the plates using a metal cutting disc which facilitated segmental removal of the affected framework. Subsequently soft tissue was manipulated to cover the defect. Discussion: Exposure is the most serious complication of reconstruction plate and necessitates a fundamental review of the therapeutic plan, including plate removal. Surgeons are faced with the clinical dilemma of stripping the plate and risking osteoradionecrosis or leaving exposed and further risking pain infection and a substandard cosmetic result. The approach we describe is an alternative method of managing this difficult problem. Conclusion: Reconstruction of composite defects of the mandible is a challenging problem in cancer surgery. We describe our approach in the successful management of two patients who experienced reconstruction plate exposure.

Item Type:	Conference or Workshop Item (Paper)
Date Type:	Publication
Status:	Published
Schools:	Dentistry
Publisher:	Elsevier
ISSN:	0901-5027
Last Modified:	07 Aug 2024 12:30
URI:	https://orca.cardiff.ac.uk/id/eprint/171179

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