Minimizing osteoradionecrosis after mandibular reconstruction and radiation in advanced head and neck cancer patients

Background Osteoradionecrosis may develop on the residual mandible or reconstructed fibula because of inadequate soft tissue coverage and compromised tissue perfusion post mandibular reconstruction, and radiation. This study was to investigate the incidence of osteoradionecrosis following class III...

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Bibliographic Details
Published in:Journal of surgical oncology 2016-09, Vol.114 (4), p.399-404
Main Authors: Gazyakan, Emre, Wu, Chih-Wei, Huang, Jung-Ju, Engel, Holger, Valerio, Ian Lee, Cheng, Ming-Huei
Format: Article
Language:English
Subjects:
Adult
Aged
Aged, 80 and over
Female
Fibula - transplantation
fibula flap
Head and Neck Neoplasms - radiotherapy
Humans
Male
mandible reconstruction
Mandibular Reconstruction - methods
Middle Aged
osteoradionecrosis
Osteoradionecrosis - etiology
peroneal artery perforator flap
plate exposure
Retrospective Studies
Surgical Flaps
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Summary:Background Osteoradionecrosis may develop on the residual mandible or reconstructed fibula because of inadequate soft tissue coverage and compromised tissue perfusion post mandibular reconstruction, and radiation. This study was to investigate the incidence of osteoradionecrosis following class III mandibular defect reconstructions with an OPAC flap versus a fibula OSC flap. Methods A retrospective review of a consecutive series of mandibular reconstructions between 1999 and 2010 was performed. Mandibular defects and corresponding flap types were analyzed with emphasis on outcome, complications, and rates of osteoradionecrosis among the two subgroups. Results A total of 121 fibula flaps were performed, consisting of 53 OPAC and 68 fibula OSC flaps. Complications trended higher for OPAC flaps in partial and total flap loss rates as well as venous congestion when compared with the OSC flap cohort. The OPAC group had statistically significant lower rates of osteoradionecrosis and plate exposure than the OSC group (P = 0.04). Conclusion The OPAC flap may be preferable to fibula OSC flap in mandibular reconstruction given its lower rates of osteoradionecrosis and plate exposure. This flap type may be the flap of choice for class III defects where additional vascularized tissue may be critical for addressing significant soft tissue deficiency. J. Surg. Oncol. 2016;114:399–404. © 2016 Wiley Periodicals, Inc.
ISSN:0022-4790
1096-9098
DOI:10.1002/jso.24321