title: Free flap reconstruction of osteoradionecrosis of the mandible: a 10-year review and defect classification.
abstract: BACKGROUND
  The purpose of this study was to evaluate outcomes of free flap reconstruction for advanced osteoradionecrosis (ORN) defects and develop an algorithm to guide surgical planning.
  
  
  METHODS
  All cases involving free flap reconstruction for ORN of the mandible between 1998 and 2008 were reviewed. A defect classification scheme was developed. Flap selection and outcomes were analyzed and evaluated by defect type.
  
  
  RESULTS
  Seventy-five free flaps and 13 pedicle flaps were performed in 63 patients. Total flap loss was 5%. Overall surgical complication was 32%. Complication rates were higher with bone flaps than with soft tissue flaps (p = .018). A full oral diet was tolerated in 57% of patients, whereas 26% required partial tube feeding, and 16% were tube-feeding dependent.
  
  
  CONCLUSIONS
  Free flap reconstruction of advanced ORN defects can be safely performed in a variety of flap configurations with good outcomes. The classification scheme may assist in flap selection.
authors.affiliation: Department of Plastic Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA.
authors.forename: Donald P
authors.initials: DP
authors.lastname: Baumann
authors.forename: Peirong
authors.initials: P
authors.lastname: Yu
authors.forename: Matthew M
authors.initials: MM
authors.lastname: Hanasono
authors.forename: Roman J
authors.initials: RJ
authors.lastname: Skoracki
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016025:Bone Transplantation / Q000379:methods; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D058752:Free Tissue Flaps / Q000098:blood supply*; D006084:Graft Rejection; D006085:Graft Survival; D006258:Head and Neck Neoplasms / Q000473:pathology / Q000532:radiotherapy / Q000601:surgery; D006801:Humans; D008297:Male; D008336:Mandibular Diseases / Q000145:classification* / Q000000981:diagnostic imaging / Q000601:surgery*; D008875:Middle Aged; D018482:Muscle, Skeletal / Q000601:surgery / Q000637:transplantation; D010025:Osteoradionecrosis / Q000145:classification* / Q000000981:diagnostic imaging / Q000601:surgery*; D011788:Quality of Life; D011879:Radiotherapy Dosage; D019651:Plastic Surgery Procedures / Q000379:methods*; D012189:Retrospective Studies; D018570:Risk Assessment; D014057:Tomography, X-Ray Computed / Q000379:methods; D016896:Treatment Outcome