ALT Rescue Flap With Iliac Crest Bone Graft and Spanning Plate for Mandibular ORN

Area of Science:

• Oral and Maxillofacial Surgery
• Reconstructive Surgery
• Oncology

Background:

• Mandibular osteoradionecrosis (ORN) following radiation therapy often requires complex surgical reconstruction.
• The standard treatment involves segmental mandibulectomy and osteocutaneous free flap reconstruction.
• Alternative reconstructive techniques are sought to improve patient outcomes and reduce morbidity.

Purpose of the Study:

• To describe the use, indications, and outcomes of combining anterolateral thigh (ALT) rescue flaps with iliac crest bone graft (ICBG) and a spanning reconstructive plate for full-thickness mandibular ORN.
• To evaluate this technique as a potential alternative to traditional free flap reconstruction.

Main Methods:

• Retrospective chart review of patients treated between January 1, 2017, and October 1, 2025.
• Inclusion criteria focused on patients undergoing reconstruction for full-thickness mandibular ORN using the described technique.

Main Results:

• Eight patients (median age 67, 87.5% male) were analyzed.
• Six patients had pre-operative fractures; two had full-thickness destruction post-debridement.
• No flap failures occurred, with 75% achieving symptom cessation and bony union at follow-up.
• Median hospital stay was 3 days, with median follow-up exceeding 25 months.

Conclusions:

• The combination of ALT rescue flap, ICBG, and spanning plate is a viable alternative for select patients with full-thickness mandibular ORN.
• This technique demonstrated low morbidity and abbreviated hospital stays.
• Further research can validate this approach in a larger patient cohort.