Highlight
– Approximately one-third of osseous microvascular midface reconstructions exhibit nonunion.
– Increased number of osteosynthesis sites, Virtual Surgical Planning (VSP), and postoperative radiation are strongly associated with nonunion.
– Postoperative complications such as fistula formation and subsequent free flap surgeries significantly correlate with impaired bony union.
– Standard clinical factors like patient age, flap type, and ischemia time do not predict union outcomes.
