Microvascular free tissue transfer for treatment of osteoradionecrosis of the maxilla.
Head and neck tumors often require radiotherapy as part of the treatment protocol. Although it improves the survival rate in cancer patients, it may cause osteoradionecrosis, especially in the mandible and maxilla. Twelve patients with osteoradionecrosis of the maxilla were treated with microsurgical free tissue transplantations between April of 1996 and August of 2002. There were 10 male and two female patients, with a mean age of 60.2 years. The mean radiotherapy dose was 6674 cGy. The radiation dose could not be traced in three patients because radiotherapy was performed elsewhere. Radical sequestrectomy, soft-tissue debridement, and pathologic proof of no tumor recurrence were performed before microsurgical reconstruction. Free flaps used included the following: anterolateral thigh (n = 7), radial forearm (n = 2), rectus femoris musculocutaneous (n = 2), and supracondylar chimeric (n = 1) flaps. All flaps survived completely and reconstruction succeeded. During a mean 25-month follow-up period, ectropion, plate exposure, and mild infection were encountered in three patients and treated successfully. Radical debridement and obliteration of dead space with well-vascularized tissue are essential for successful treatment of maxillary osteoradionecrosis. The anterolateral thigh flap is most versatile for almost all types of soft-tissue defect reconstruction in the head and neck region.
Coskunfirat
O Koray
OK
Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital and Medical College, Chang Gung University, Taipei, Taiwan.
Wei
Fu-Chan
FC
Huang
Wei-Chao
WC
Cheng
Ming-Huei
MH
Yang
Wen-Guei
WG
Chang
Yang-Ming
YM
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002277:Carcinoma / Q000532:radiotherapy / Q000601:surgery; D003131:Combined Modality Therapy; D003646:Debridement; D004483:Ectropion / Q000209:etiology; D005260:Female; D005402:Fistula / Q000209:etiology / Q000601:surgery; D005500:Follow-Up Studies; D006258:Head and Neck Neoplasms / Q000532:radiotherapy / Q000601:surgery; D006801:Humans; D008297:Male; D008437:Maxilla / Q000528:radiation effects; D008439:Maxillary Diseases / Q000209:etiology / Q000601:surgery*; D008866:Microsurgery / Q000379:methods*; D008875:Middle Aged; D009668:Nose Diseases / Q000209:etiology / Q000601:surgery; D016155:Oral Fistula / Q000209:etiology / Q000601:surgery; D010025:Osteoradionecrosis / Q000601:surgery*; D011183:Postoperative Complications / Q000209:etiology / Q000601:surgery; D019651:Plastic Surgery Procedures / Q000379:methods*; D012189:Retrospective Studies; D013524:Surgical Flaps; D013530:Surgical Wound Infection / Q000209:etiology