The role of the osteocutaneous radial forearm free flap in the treatment of mandibular osteoradionecrosis.
OBJECTIVE
To evaluate the role of the osteocutaneous radial forearm free flap (OCRFFF) in the treatment of mandibular osteoradionecrosis (ORN).


METHODS
Retrospective case review of patients who underwent OCRFFF oromandibular reconstruction after resection of nonviable tissue at an academic tertiary care center because of ORN. Patients with reconstructions other than OCRFFF were excluded from this study.


RESULTS
Nine patients underwent a composite oromandibular resection for ORN with a reconstruction using an OCRFFF between April 1998 and February 2003. All patients had failed previous less aggressive surgical and medical management of the ORN. Mean follow-up was 36 months (range, 14-67 months). There were no flap failures or significant immediate postoperative or long-term complications observed. All patients had successful restoration of mandibular integrity and continuity, with 100% success rate of stabilization of ORN. All patients were able to tolerate PO diet, with only one third having to supplement their diet with gastrostomy feedings, compared with 89% gastrostomy dependence preoperatively.


CONCLUSIONS
Primary or adjuvant radiotherapy for head and neck malignancies can result in ORN of the mandible. This difficult problem often requires surgical intervention. In our experience, the OCRFFF can be successfully used for oromandibular reconstruction, even in the setting of the heavily radiated tissue with excellent postoperative outcomes.


CONCLUSIONS
This is the first study that demonstrates the efficacy of the OCRFFF as a treatment of mandibular ORN.
Militsakh
Oleg N
ON
Department of Otorhinolaryngology-Head and Neck Surgery, University of Kansas School of Medicine, Kansas City 66160, USA.
Wallace
Derrick I
DI
Kriet
J David
JD
Tsue
Terance T
TT
Girod
Douglas A
DA
D000368:Aged; D002294:Carcinoma, Squamous Cell / Q000532:radiotherapy*; D005260:Female; D005542:Forearm / Q000601:surgery; D006085:Graft Survival; D006258:Head and Neck Neoplasms / Q000532:radiotherapy*; D006801:Humans; D008297:Male; D008336:Mandibular Diseases / Q000209:etiology / Q000601:surgery*; D008545:Melanoma / Q000532:radiotherapy; D008875:Middle Aged; D010025:Osteoradionecrosis / Q000209:etiology / Q000601:surgery*; D011878:Radiotherapy / Q000009:adverse effects; D011884:Radius / Q000637:transplantation; D012189:Retrospective Studies; D013524:Surgical Flaps; D016896:Treatment Outcome