The indications for mandibular reconstruction using a mandibular reconstruction plate (MRP) and free flap, and the complication-reducing technique remain controversial.
In 2014, one investigator reported on the “no touch technique,” which protected the MRP from oral saliva exposure to prevent postoperative MRP infection. We developed an easier method that was comparable with this technique. We report this new procedure and the complications that developed in an additional 30 cases of mandibular reconstruction.
Between 2016 and 2019, 29 patients (22 men, 7 women; mean age, 70.0 years) underwent 30 mandibular reconstructions using the MRP and free flap. In 15 cases during reconstruction, the MRP and screws were removed from the mandible and soaked in a povidone-iodine solution during microvascular anastomosis. Before this maneuver, the MRP and screws were exposed temporarily to oral mucosa and saliva, which meant that the “no-touch” technique was no longer maintained.
A rectus abdominis musculocutaneous flap was used in 25 cases (83.3%) and an anterolateral thigh flap (ALT) was used in 5 (16.7%) . All free flaps survived except for two ALTs that had partial flap necrosis. MRP exposure was noted in 3 cases (10.0%) , but it was not related to MRP infection.
This procedure may be sufficient to prevent local infection of the MRP.
