Osseous free flap vs. Bridging plate mandibular reconstruction: a retrospective cohort study on perioperative complications of 335 patients.

[OBJECTIVES] This study compared postoperative complication rates between bridging plate reconstruction with soft tissue free flaps and osseous free flaps for segmental mandibular defects.

[MATERIALS AND METHODS] This retrospective study compared postoperative outcomes between both techniques in 335 reconstructions of segmental mandibular defects operated over 8 years. The N-1 χ-test, Fisher’s exact test and Mann-Whitney-U test were used to test for statistical significance after mode and mean imputation were performed on independent variables with missing data.

[RESULTS] Patients who received bridging plate reconstructions were significantly older (74.4 ± 10.5 vs. 63.4 ± 10.6 years,  < 0.001) and had higher rates of hypertension (67.6% vs. 40.6%,  = 0.002), atherosclerosis (27.0% vs. 12.8%,  = 0.020), and prophylactic anticoagulation (21.6% vs. 8.7%,  = 0.014). Treatment indications differed significantly, with malignant tumors in 59.5% vs. 78.5% and osteonecrosis in 40.5% vs. 21.5% of bridging plate and osseous reconstructions, respectively ( < 0.001). Mortality (24.3% vs. 10.1%,  = 0.011) and pneumonia rates (13.5% vs. 4.7%,  = 0.029) were higher in the bridging plate group. Plate exposure (21.6% vs. 24.8%,  = 0.669), fixation failure (5.4% vs. 6.0%,  = 0.878), and early flap loss (5.4% vs. 4.4%,  = 0.773) showed no significant differences. Bridging plate reconstructions had shorter surgery times (8.4 ± 2.0 vs. 9.6 ± 2.2 h,  = 0.002) and fewer wound infections (13.5% vs. 30.9%,  = 0.028).

[CONCLUSIONS] Our findings emphasize the value of bridging plate reconstruction as a pragmatic and effective option when osseous reconstruction is contraindicated and advocate for personalized treatment strategies.

[CLINICAL RELEVANCE] These findings validate bridging plate reconstruction as a safe and pragmatic alternative for patients with contraindications to osseous flaps, such as advanced age or significant comorbidities. The comparable complication rates and shorter operative times support its use in personalized treatment planning.

[SUPPLEMENTARY INFORMATION] The online version contains supplementary material available at 10.1007/s00784-026-06753-7.