Complication rates and clinical outcomes of osseous free flaps: a retrospective comparison of CAD/CAM versus conventional fixation in 128 patients

Studies evaluating plate-related complications in patient-specific versus conventional fixation systems in free flap surgery are lacking. This was a retrospective study of 128 osseous free flaps with a minimum follow-up of 12 months. Wound healing disorders, plate exposure, fixation failure, and subtotal osseous union were recorded and evaluated statistically by univariate and regression analysis. Complication rates were as follows: wound healing disorders 33.6% (computer-aided design and computer-aided manufacturing (CAD/CAM) vs. conventional: 35.1% vs. 33.0%); plate exposure 21.9% (29.7% vs. 18.7%); fixation failure 7.0% (8.1% vs. 6.6%); subtotal osseous union 36.7% (45.9% vs. 33.0%). Radiotherapy (P<0.001) and more than two segments (P=0.026) were independent variables for the overall complication rate and were negatively correlated with the dental implantation rate. The time between diagnosis and ablative surgery was increased by 11.0days in the CAD/CAM group (34.2±16.2days vs. 23.2±12.0 days; P=0.002). Rates of dental rehabilitation were not significantly different (35.1% vs. 44.0%, P=0.358). On average, 3.2±1.7 dental implants were placed into flap segments. Plate-related complications were increased with radiotherapy and multisegment flaps. There was a non-significant trend towards increased complications with patient-specific plates in comparison to conventional reconstruction plates.