Abstract
The purpose of this study is to evaluate the outcomes of the use of microvascular free flaps (MVFF’s) in the management of advanced stage III osteoradionecrosis (ORN) that fails conservative management. This is a retrospective review of all patients treated for ORN with radical resection and microvascular reconstruction at the University of Maryland department of oral & maxillofacial surgery between July of 2010 and October of 2012. Outcomes measured included the resolution rate (resolution of pain, infection, and exposed bone) as well as perioperative complications. There were 12 patients (10 men and two women) (eight caucasians, three blacks, and one hispanic). The mean age at time of treatment was 62 years. Mean follow up was 15 months. All had Marx stage III ORN. Six patients had radiation therapy alone, and 6 had combined chemoradiation. The presenting features included pain (10 patients), orocutaneous fistulas (4), exposed bone (11), and pathologic fracture (8). Eight patients had hyperbaric oxygen (HBO) as part of their conservative treatment. The mean latency period between completion of adjuvant therapy and development of symptoms was 6.7 years (10–312 months). Seven patients were reconstructed with a fibula flap, four with a scapula flap, and one with a deep circumflex iliac artery flap. The resolution rate was a 100% with resolution of pain, drainage, and exposed bone. The perioperative complication rate was 50%. One flap developed vascular compromise, and was successfully salvaged. Four patients had postoperative infections which required a washout and drainage, one had a hematoma evacuation. Three patients have chronic dysphagia and are partially PEG tube dependent. Resection and microvascular reconstruction is a highly predictable mode of treatment for advanced ORN. The increased postoperative complication rate is consistent with the literature, and is expected given the poor quality fibrotic tissue in radiated patients.
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