Mandibular revascularization using a humeral periosteal free flap: A technical note.

Area of Science:

• Oral and Maxillofacial Surgery
• Regenerative Medicine
• Oncology

Background:

• Osteoradionecrosis (ORN) of the jaw is a debilitating complication following radiation therapy for head and neck cancers.
• Recurrent ORN poses significant challenges for reconstructive surgery, often requiring complex tissue transfer.
• Existing reconstructive methods may involve high morbidity or sacrifice of major blood vessels.

Purpose of the Study:

• To describe a surgical technique utilizing a vascularized periosteal free flap for the treatment of recurrent osteoradionecrosis of the lower jaw.
• To evaluate the feasibility and potential benefits of this flap in ORN reconstruction.
• To highlight the regenerative and osteogenic potential of the transposed periosteal tissue.

Main Methods:

• A vascularized periosteal free flap, specifically from the humerus, was employed.
• The technique involves transposing non-irradiated soft tissue with inherent neoangiogenesis, bone induction, and osteogenesis capabilities.
• The surgical procedure was designed to minimize morbidity and avoid sacrifice of major vessels.

Main Results:

• The humeral periosteal free flap demonstrated successful transposition of viable, non-irradiated tissue.
• The flap possesses qualities conducive to bone regeneration, including neoangiogenesis, bone induction, and osteogenesis.
• The described technique is associated with low patient morbidity.

Conclusions:

• The vascularized humeral periosteal free flap is a viable and effective option for treating recurrent osteoradionecrosis of the lower jaw.
• This revascularization approach offers a low-morbidity alternative to conventional flap procedures.
• Early consideration of this technique may prevent further damage and simplify complex reconstructions in ORN patients.