Analysis of outcomes of vascularized flap reconstruction in patients with advanced mandibular osteoradionecrosis

OBJECTIVE: To examine outcomes of vascularized bone flap reconstruction of end-stage osteoradionecrosis of the mandible. STUDY DESIGN: Case series with planned data collection. SETTING: Tertiary care academic hospital. SUBJECTS: Patients with end-stage radiation-induced osteoradionecrosis (ORN) refractory to conservative therapy with wound complications including chronic infections, fistula formation, and pathologic fracture were included. RESULTS: Outcomes of 33 patients were prospectively collected and analyzed, making this the largest series on this subject in the literature and the only one with planned data collection. Data on preoperative variables including radiation dose, sub-site location, treatment date, and prior therapy, along with intraoperative issues and postoperative outcomes, were tracked and are presented. ORN was seen to develop in a bimodal distribution based on the timing of interval surgical intervention. The extent of local soft tissue injury often required the use of contralateral recipient vessels. Local wound complication rates were higher than that seen in primary reconstructions. CONCLUSIONS: Successful reconstruction was achieved in all of the patients in this series. Long-term resolution of infectious complication and disease resolution was seen in 91 percent of the patients in this series. (c) 2009 American Academy of Otolaryngology-Head and Neck Surgery Foundation. All rights reserved.