Application of Vacuum-Assisted Closure Therapy and Hyperbaric Oxygen Therapy for an Exposed Titanium Plate After Mandible Reconstruction.

The authors report a case of an 84-year-old woman with an exposed mandibular plate after reconstruction, which finally healed with combination therapy using vacuum-assisted closure therapy and hyperbaric oxygen therapy. The woman was diagnosed with mucosal carcinoma of the right oral cavity. During reconstruction after segmental excision of the mandible, a titanium plate was selected based on several risk factors. After the operation, the plate became exposed at the center of the chin. A second surgery was deemed inappropriate because of her age, malnutrition, and recurrent aspiration pneumonia. Instead, combination therapy consisting of vacuum-assisted closure therapy and hyperbaric oxygen therapy was initiated, leading to epithelizaion of the wound. Adapt Barrier Rings was effectively used to generate a stable negative pressure at the complicated craniofacial wound. A surgical or conservative approach is chosen as salvage treatment of an exposed plate. In this patient, only conservative treatment involving combination therapy resulted in complete healing of the wound with plate exposure. This patient highlights 2 important clinical issues: combination therapy was effective for an exposed mandibular plate, and a dressing technique using Adapt Barrier Rings enabled stable negative pressure in the craniofacial wound.