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The outcome of digital technology in microvascular free flap reconstruction for ORNJ: a retrospective study
Xinyue Xu1, Zihao Tang1, Dandan Wang1
1National Clinical Research Center for Oral Diseases, State Key Laboratory of Oral and Maxillofacial Reconstruction and Regeneration, Shaanxi Clinical Research Center for Oral Diseases, Department of Oral and Maxillofacial Surgery, School of Stomatology, The Fourth Military Medical University, Xi'an, Shaanxi, China.
Background:
Osteoradionecrosis of the jaw (ORNJ) is a serious and refractory late complication of radiotherapy used in the treatment of head and neck cancer. Microvascular free flap reconstruction is an ideal option to reconstruct the residual defect after surgical resection of ORNJ lesion. The application of virtual surgical planning (VSP) and three-dimensional printing (3DP) can effectively improve the reconstructive results with free flaps in jaw bone defect. However, the effect of VSP and 3DP in ORNJ reconstruction with free flaps is still unclear. A retrospective study was conducted to evaluate the free flap types, the success rate, and complications in ORNJ.
Methods:
The ORNJ inpatients that underwent free flaps reconstruction in our hospital between 2012 and 2024 were included in the study and divided into the conventional flap (CF) and digital flap (DF) groups with the application of VSP and 3DP. The patient characteristics and microvascular free flap reconstruction outcome were reviewed.
Results:
A total of 35 ORNJ patients with 39 free flaps were included in the study. The success rate of free flaps reconstruction in ORNJ was 89.7%, with the postoperative early complication rate of 58.9% and late complication rate of 25.6%. Fibula was the most commonly used flap type (76.9%) of ORNJ defect reconstruction and had the lowest complication rate (63.3%). The success rate between the CF (92.9%) and DF (88%) groups had no significant difference. The mean surgical duration and the length of hospital stay in the DF group were significantly shorter than those of the CF group. Moreover, the difference of the postoperative complication rate between the CF (78.6%) and DF (64%) groups was not statistically significant. The fistula formation rate was significantly lower in the DF group than in the CF group.
Conclusion:
Microvascular free flap reconstruction is safe and effective for advanced osteoradionecrosis of the jaw, with the fibula flap representing the most favorable donor site. The adjunctive use of virtual surgical planning and three-dimensional printing significantly reduces the operative time, length of hospital stay, and fistula formation. These digital techniques are valuable adjuvant tools that optimize surgical efficiency and decrease critical complications in ORNJ reconstruction.