Background: This study aimed to identify the risk factors for postoperative plate exposure in head and neck cancer patients with composite mandibular defects undergoing tumor ablation followed by bridging plate and anterolateral thigh (ALT) flap transfer.
Methods: Between January 2007 and June 2012, 1,452 patients who underwent free tissue transfer after head and neck cancer ablation were retrospectively reviewed. Only ALT flap coverage with a bridging plate for segmental mandibular defects was included. The Jewer's classification was used to define the type of mandibular defect.
Results: The study enrolled 123 men and 7 women. The incidence of plate exposure was 37.7 % (49/130). The follow-up time ranged from 0.5 to 5.4 years (mean, 2.4 years). The 5-year probability of a plate exposure-free rate was 32.8 % for the patients with postoperative radiotherapy (RT) (n = 33) and 64.3 % for the patients without it (n = 97). Patients reconstructed with a fasciocutaneous or chimeric type of ALT flap had higher rates of plate exposure than those reconstructed with a musculocutaneous type of ALT flap (p = 0.002). As shown by logistic regression, the significant predictive risk factors for postoperative plate exposure still were postoperative RT [adjusted odds ratio (OR) 2.76, 95 % confidence interval (CI) 1.09-6.99, p = 0.031] and intraoperative blood loss (adjusted OR 2.37, 95 % CI 1.13-4.99, p = 0.022).
Conclusions: The type of ALT flap, postoperative RT, and intraoperative blood loss were the predisposing factors for increased risk of postoperative plate exposure in the specific disease group.