Outcomes of sequential microvascular tissue transfer for radiation induced sequelae post mandibular reconstruction
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Updated: Nov 9, 2026
Digitally Guided Intraoral Segmental Mandibulectomy and Fibula Flap Reconstruction for Locally Invasive Odontogenic Tumors
Published on: April 7, 2026
Karnav Panchal1, Sagnika Ukil1, Neha Kalwadia1
1Department of Plastic, Reconstructive and Microsurgery, TATA Medical Center, Kolkata, India.
Background:
Radiotherapy-related complications following mandibular reconstruction remain a major challenge in head and neck oncologic reconstruction. Although free fibula flap reconstruction has become the gold standard for segmental mandibular defects, delayed radiation-induced sequelae such as hardware exposure, contour deformity, soft tissue atrophy, fistula formation continue to affect long-term outcomes. Literature regarding the role of sequential microvascular tissue transfer in managing these complications remains limited.
Objectives:
This study aims to evaluate the indications, surgical planning, recipient vessel selection, and outcomes of sequential microvascular free tissue transfer performed for radiation-induced sequelae after mandibular reconstruction.
Materials And Methods:
A retrospective observational study was conducted between June 2024 and December 2025 at a tertiary referral center. Patients who had previously undergone primary mandibular reconstruction using a fibula free flap followed by adjuvant radiotherapy and later developed radiation-related complications requiring secondary microvascular reconstruction were included. Demographic data, primary reconstructive details, radiation parameters, duration between radiation and complication, indications for sequential reconstruction, flap characteristics, recipient vessel selection, postoperative complications, and healing outcomes were analyzed.
Results:
Ten patients were included in the study. All patients had undergone primary fibula free flap reconstruction following segmental mandibulectomy followed by sequential microvascular soft tissue reconstruction for radiation induced complications. Ipsilateral superficial temporal vessels were used as recipient vessels in all cases without using vein grafts. All flaps survived completely. Satisfactory wound healing and contour restoration were achieved in all patients.
Conclusion:
Sequential microvascular reconstruction represents a reliable and effective strategy for managing radiation-induced complications following mandibular reconstruction. Volume loss can be addressed during plate removal surgery which not only achieves a stable soft tissue cover but also prevents further progression to osteoradionecrosis.
