Multicenter Comparison of Modern Plating Options in Fibula, Scapula, and Osteocutaneous Radial Forearm Free Flaps

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OBJECTIVES: Evaluate the association of plating strategies with hardware removal and operative time, after adjusting for relevant clinical variables. STUDY DESIGN: Retrospective Review. SETTING: Multiple Academic Medical Centers. METHODS: Patients undergoing osseous free flap reconstruction stratified based on the plating strategy [conventional plating with a hand-bent plate, precontoured plate, and virtual surgical planning (VSP) with patient-specific hardware and cutting guides]. Variables associated with hardware removal were analyzed using multivariable logistic regression. To evaluate the effect of plating strategy on operative time, a multivariable linear regression model was created. Adjusted odds ratios (aOR) with 95% confidence intervals (CI) were calculated. RESULTS: 1022 patients were analyzed: 650 (63.6%) conventional plate, 163 (15.9%) precontoured plate, and 209 (20.5%) VSP. Compared to conventional plating (aOR: 1.00), VSP was independently associated with lower odds of hardware removal (aOR: 0.39, 95% CI: 0.23-0.68), while there was no difference with precontoured plates (aOR: 0.84, 95% CI: 0.52-1.38). Compared to conventional plates, precontoured plates were associated with a reduction in operative time of 31.13 minutes (95% CI: 2.93-59.33), and VSP was associated with a reduction in 76.87 minutes (95% CI: 50.15-103.57), adjusting for flap type and defect length. CONCLUSIONS: This multi-institutional study demonstrates that head and neck osseous reconstruction with customized, patient-specific hardware and VSP is associated with a lower rate of hardware removal and shorter operative time compared to precontoured or hand-bent hardware. Additionally, cases utilizing precontoured hardware were associated with shorter operative time, but similar rates of hardware removal compared to conventional plates.

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