Free flap reconstruction of osteoradionecrosis of the mandible: A 10-year review and defect classification

• Published in: Head & neck 2011-06, Vol.33 (6), p.800-807
• Main Authors: Baumann, Donald P., Yu, Peirong, Hanasono, Matthew M., Skoracki, Roman J.
• Format: Article
• Language: English
• Subjects: Adult; Aged; Aged, 80 and over; Algorithms; Biological and medical sciences; Bone Transplantation - methods; Classification; Cohort Studies; defect classification; Diets; Diseases of the osteoarticular system; Feeding; Female; Follow-Up Studies; free flaps; Free Tissue Flaps - blood supply; Graft Rejection; Graft Survival; Head; Head and Neck Neoplasms - pathology; Head and Neck Neoplasms - radiotherapy; Head and Neck Neoplasms - surgery; Humans; Male; Mandible; mandible reconstruction; Mandibular Diseases - classification; Mandibular Diseases - diagnostic imaging; Mandibular Diseases - surgery; Medical sciences; Middle Aged; Muscle, Skeletal - surgery; Muscle, Skeletal - transplantation; Neck; Osteoradionecrosis; Osteoradionecrosis - classification; Osteoradionecrosis - diagnostic imaging; Osteoradionecrosis - surgery; Otorhinolaryngology. Stomatology; Quality of Life; Radiotherapy Dosage; Reconstruction; Reconstructive Surgical Procedures - methods; Retrospective Studies; Risk Assessment; Soft tissues; through-and-through defects; Tomography, X-Ray Computed - methods; Treatment Outcome; Vascular bone diseases
• ISSN: 1043-3074; 1097-0347; 1097-0347
• DOI: 10.1002/hed.21537

Background The purpose of this study was to evaluate outcomes of free flap reconstruction for advanced osteoradionecrosis (ORN) defects and develop an algorithm to guide surgical planning. Methods All cases involving free flap reconstruction for ORN of the mandible between 1998 and 2008 were reviewed. A defect classification scheme was developed. Flap selection and outcomes were analyzed and evaluated by defect type. Results Seventy‐five free flaps and 13 pedicle flaps were performed in 63 patients. Total flap loss was 5%. Overall surgical complication was 32%. Complication rates were higher with bone flaps than with soft tissue flaps (p = .018). A full oral diet was tolerated in 57% of patients, whereas 26% required partial tube feeding, and 16% were tube‐feeding dependent. Conclusion Free flap reconstruction of advanced ORN defects can be safely performed in a variety of flap configurations with good outcomes. The classification scheme may assist in flap selection. © 2010 Wiley Periodicals, Inc. Head Neck, 2011