Free flap reconstruction for osteoradionecrosis of the jaws--outcomes and predictive factors for success

Head Neck. 2011 Mar;33(3):424-8. doi: 10.1002/hed.21463.

Abstract

Background: The purpose of this study was to determine factors to predict the success of free flap surgery in the treatment of osteoradionecrosis (ORN).

Methods: Univariate analysis of overall and flap complications was performed. The effect of time to ORN, and the time interval between ORN to reconstruction was evaluated.

Results: Fifty-five flaps on 53 patients for ORN were done with a 90% resolution rate. Univariate parameter analysis was significant for infield mandibulotomy. An increased time interval from radiation therapy (XRT) to ORN development significantly predicted for flap-specific complications and flap loss (p < .05). Increased time from ORN diagnosis to flap surgery resulted in greater length of bone involvement (p = .01). Anastomotic complications occurred in 13 cases resulting in 7 complete flap losses.

Conclusion: An increased risk of complication was encountered with greater time from XRT to ORN. Thus, in patients developing ORN long after treatment, surgery should be accordingly more aggressive.

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Analysis of Variance
  • Chi-Square Distribution
  • Cohort Studies
  • Female
  • Follow-Up Studies
  • Free Tissue Flaps / blood supply*
  • Graft Rejection
  • Graft Survival
  • Head and Neck Neoplasms / mortality
  • Head and Neck Neoplasms / pathology
  • Head and Neck Neoplasms / radiotherapy*
  • Humans
  • Jaw / radiation effects
  • Logistic Models
  • Male
  • Middle Aged
  • Neoplasm Staging
  • Orthognathic Surgical Procedures*
  • Osteoradionecrosis / pathology
  • Osteoradionecrosis / surgery*
  • Postoperative Complications / physiopathology
  • Predictive Value of Tests
  • Reconstructive Surgical Procedures / adverse effects
  • Reconstructive Surgical Procedures / methods*
  • Retrospective Studies
  • Risk Assessment
  • Survival Analysis
  • Treatment Outcome