Use of reconstruction plates in conjunction with soft-tissue free flaps for oromandibular reconstruction.

The plate-flap option has a place in oromandibular reconstruction: It allows an expedient method to obtain an excellent cosmetic and functional result with minimal donor site disability. It is best for lateral and posterior low-volume defects in the debilitated, the elderly, and in those patients with a poor prognosis. This technique may be used as a preliminary to vascularized bone grafts in patients receiving postoperative radiotherapy. This method is no panacea. These are very specific indications for its use. Failure usually requires rescue with a vascularized bone graft. With proper selection of patients, however, this will rarely be necessary. A major weakness in the plating systems available at present is their tendency to fracture if they remain in place too long. The gauntlet is, therefore, thrown down to those in a position to develop more reliable hardware.