Risk factors for reconstruction plate exposure after surgery in oral cancer patients. A retrospective cohort study.

Objectives: The aim of this study was to elaborate risk factors for reconstruction plate exposure after wide excision in oral cancer patients, and to find out the most effective treatment.

Materials And Methods: We include patients who underwent ablative surgery for oral cancer and reconstruction plate fixation from the year 2010 to 2016, separate them into two groups according to whether the hardware was exposed, compare risk factors including age, tumor site, staging, comorbidities, and previous treatment between the two groups. The treatment course and outcome were also recorded.

Results: In total, 75 patients received reconstruction plate fixation after ablative surgery. Bone plate exposure was found in 26 cases (34.6%). The size of the bone defect and the thickness of soft tissue covering the plate were significant risk factors for plate exposure. In 21 patients (72.4%), the bone plate was removed. Conservative treatment was not effective. Removal of bone plate and debridement in one single surgery had a success rate of 81%.

Conclusion: In this study, skin thickness less than 1.5 mm over the reconstruction plate and bone defect size larger than 8.4 cm were the two significant risk factors for bone plate exposure. Although a standardized treatment algorithm is lacking, surgical debridement with removal of the bone plate result in complete soft tissue healing in most patients and should be the treatment of choice.

Clinical Relevance: Patients with larger bone defect and thinner covering soft tissue bear more risk for exposure. The most effective treatment is to remove the hardware.