Background: Free fibula osteocutaneous flap is one of the popular and reliable flaps for reconstruction after segmental mandibulectomy according to its advantages of two-team approach, chimeric designing, straight fibula bone, sufficient bone length, and segmental blood supply. However, the utility of reconstruction bar or miniplate is still controversial. The aim of this study is to figure out which kind of plate ultimately lead to long-term complications and plate removal may thus be necessary.

Patients and Methods: The comparison was performed by a retrospective review of patients undergoing free fibular flap reconstruction of the mandible in the past decade (2011/01-2020/09) in a single tertiary institution. Patients’ demographics, comorbidities, intraoperative variants, treatments, and long-term outcomes were recorded. Cases experienced acute thromboembolic events, followed up less than one year, or combined the two kinds of plates were excluded.

Results: A total of 148 patients were included and reconstruction bar was in majority (n=129). Fifty-five patients (37.2%) required plate removal for complications in a mean follow-up time of 56.0 months. Patients who underwent reconstruction bar installation have no significant difference on late complications (plate exposure, 10.9% vs. 26.3%, p=0.63; infection, 12.4% vs. 15.8%, p=0.24; and fistula formation, 12.4% vs. 15.8%, p=0.76) and plate removal (36.4% vs. 42.1%, p=0.64) in comparison to the group using miniplate, respectively. Furthermore, there was no significant difference on plate removal in these two groups after adjusting for confounders in multivariate analysis.

Conclusion: Although removal of metallic plates may sometimes be indicated due to long-term complications of free fibula osteocutaneous flaps on mandible reconstruction, there was no remarkable difference in selection of reconstruction bar or miniplate for bone fixation.