Risks of Miniplate Removal in Fibula Free Flap Oromandibular Reconstruction

Abstract Objective To identify clinical and surgical risk factors for miniplate removal after oromandibular reconstruction with fibula free flap (FFF) and evaluate the timing of this complication. Study Design This was a retrospective cohort study. Setting This study was conducted at Kaohsiung Veterans General Hospital, a tertiary care center, from January 2015 to December 2023. Patients undergoing oromandibular reconstruction with FFF were categorized by miniplate removal status. Methods The incidence of miniplate removal and postoperative complications were analyzed. Multivariate logistic regression identified independent risk factors, and Kaplan‐Meier analysis assessed the time to miniplate removal. Results Out of 184 patients, 30 (16.3%) experienced miniplate issue required removal. This group showed significantly higher complication rates, including abscess/fistula (53.3% vs 5.8%), osteomyelitis (43.3% vs 0.6%), and osteoradionecrosis (23.3% vs 2.6%) ( P < .001 for all). Preoperative or postoperative radiotherapy (OR, 9.27; P = .046) and number of osteotomies (OR, 3.77; P = .038) were identified as independent risk factors. Kaplan‐Meier analysis indicated a trend of higher miniplate removal rates in the radiotherapy group ( P = .055), with the highest risk within the first 30 months. Conclusion Radiotherapy and an increased number of osteotomies are independent risk factors for miniplate removal after FFF reconstruction. The risk is particularly high in irradiated patients within the first 30 months post‐surgery, emphasizing the need for tailored surgical planning and close monitoring.