Comparative osteoradionecrosis rates in bony reconstructions for head and neck malignancy

Area of Science:

• Oral and Maxillofacial Surgery
• Oncology
• Plastic and Reconstructive Surgery

Background:

• Bony free flaps are crucial for head and neck cancer defect reconstruction.
• Free fibula and deep circumflex iliac artery (DCIA) flaps are commonly used.
• Postoperative radiotherapy can lead to osteoradionecrosis (ORN), a bone complication.

Purpose of the Study:

• To compare the incidence of osteoradionecrosis (ORN) between free fibula flaps and DCIA flaps.
• To assess the impact of ORN on flap selection for head and neck cancer reconstruction.

Main Methods:

• Retrospective cohort study of 154 patients undergoing head and neck cancer reconstruction.
• Involved patients from Royal Melbourne Hospital and St Vincent's Hospital Melbourne over 10 years.
• Utilized demographic, operative, and postoperative data with statistical analyses.

Main Results:

• 12 patients developed ORN (10 with free fibula flaps, 2 with DCIA flaps).
• No statistically significant difference in ORN rates was found between the two flap types.
• Free fibula flaps were used in 127 patients, and DCIA flaps in 27 patients.

Conclusions:

• Osteoradionecrosis (ORN) incidence is comparable between free fibula and DCIA flaps.
• ORN rates should not be a primary factor in preoperative planning for mandibular reconstruction.
• Both flap types demonstrate similar outcomes regarding ORN in head and neck cancer reconstruction.