Titanium miniplate fixation in free flap mandible reconstruction.

The use of miniplate fixation in free flap mandible reconstruction was reviewed in a series of 27 patients. Flap donor sites included the radius, scapula, and fibula. The bone defect ranged from 5 to 16 cm (mean, 11.5 cm). The number of fixation sites per graft ranged from 2 to 6 (mean, 3.96). Three to 10 (mean, 5.51) titanium miniplates (Wurzburg) were used for fixation. All free flaps survived. In no patient did the plate pressure on the periosteum or the multiple screws through the bone compromise flap circulation to a critical degree. Nonunion occurred in 2 of 107 osteotomy sites. Wound healing problems that required plate removal occurred in 4 patients. In each patient the plates were retained until bone healing was complete. Intermaxillary fixation was not necessary for purposes of additional stability. Miniplates have the advantages of ease of application, decreased fixation time, and the lack of need for additional forms of fixation. Their small size and malleable nature allow precise graft contouring. This contributes to a superior aesthetic result.