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Lessons learned from reconstructing advanced osteoradionecrosis with free vascularized flaps: a retrospective study

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BackgroundAt present, there is no universally accepted standard of care for osteoradionecrosis (ORN), and comprehensive clinical guidelines remain absent. The primary objective of this study is to offer insights into the effectiveness and safety of microvascular reconstruction approach in patients with ORN.MethodsA retrospective analysis was conducted on all patients who underwent free flap reconstruction following a diagnosis of ORN by the senior author, from 2005 to 2022. Data regarding the patient's demographics, comorbidities, previous treatments, ORN classification, postoperative complications, and therapeutic outcome were collected.ResultsFifty-three free flaps were carried out in a cohort of 48 patients. One maxilla ORN and 42 mandible ORN were treated. The most common flap chosen was free fibula flap. The only risk factor that was statistically significant for major complications was previous neck dissection. Concerning complications after discharge, 41 patients had follow-up with an average follow-up duration of 60 months. Exposure of osteosynthesis material and fistula were the most common long-term complications that required return to the OR. Only 11.36% had recurrence of ORN.ConclusionsThe iliac crest flap represents a valuable option for mandible reconstruction. However, this preference does not extend to ORN; fibula flap remains the optimal choice. It is worth noting that flap and complication rates are notably higher in ORN. Patients with a history of neck dissection are at a heightened risk of complications. Our study demonstrates a reassuring outcome as ORN recurrence occurred approximately in only one out of eight patients.Level of evidence: Level IV, risk/prognostic.ConclusionsThe iliac crest flap represents a valuable option for mandible reconstruction. However, this preference does not extend to ORN; fibula flap remains the optimal choice. It is worth noting that flap and complication rates are notably higher in ORN. Patients with a history of neck dissection are at a heightened risk of complications. Our study demonstrates a reassuring outcome as ORN recurrence occurred approximately in only one out of eight patients.Level of evidence: Level IV, risk/prognostic.

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Osteoradionecrosis Free flap Mandible Radiotherapy

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