title: Use of recombinant bone morphogenetic protein 2 in free flap reconstruction for osteonecrosis of the mandible.
abstract: OBJECTIVE
  Osteoradionecrosis of the mandible is a debilitating consequence of radiation therapy for head-and-neck malignancy. It can result in pain, bone exposure, fistula formation, and pathologic fracture. Recombinant human bone morphogenetic protein 2 (rhBMP-2) has shown promise in reconstruction of bone defects. The purpose of this study is to determine whether the addition of rhBMP-2 at the union of vascularized bone and native bone improves surgical outcomes in patients with osteonecrosis of the mandible.
  
  
  METHODS
  This study was a retrospective analysis of patients who were treated between 2006 and 2010 for osteonecrosis of the mandible. Patients requiring definitive reconstruction after failure of a course of conservative management were included. Patients were divided into 2 cohorts depending on whether rhBMP-2 was used during the reconstruction. The primary outcome measure was defined as stable mandibular union.
  
  
  RESULTS
  Seventeen patients were included. The development of malunion was similar in both groups (13% for rhBMP-2 group vs 11% for non-rhBMP-2 group). Infectious complications were similar between the groups (25% in rhBMP-2 group vs 56% in non-rhBMP-2 group, P = .33). The rates of hardware removal were similar for the 2 groups (33% in non-rhBMP-2 group vs 25% in rhBMP-2 group, P = .10). No cancer recurrences were observed in patients receiving rhBMP-2.
  
  
  CONCLUSIONS
  The use of rhBMP-2 is safe in free flap reconstruction of the mandible, but its ability to significantly improve patient outcomes, as measured by rates of malunion, reoperation, or infection, is still unknown.
authors.affiliation: National Institutes of Health Research Fellow, Department of Surgery, Division of Otolaryngology-Head and Neck Surgery, University of Alabama at Birmingham, Birmingham, AL 35294-0012, USA.
authors.forename: Larissa
authors.initials: L
authors.lastname: Sweeny
authors.forename: William P
authors.initials: WP
authors.lastname: Lancaster
authors.forename: Nichole R
authors.initials: NR
authors.lastname: Dean
authors.forename: J Scott
authors.initials: JS
authors.lastname: Magnuson
authors.forename: William R
authors.initials: WR
authors.lastname: Carroll
authors.forename: Patrick J
authors.initials: PJ
authors.lastname: Louis
authors.forename: Eben L
authors.initials: EL
authors.lastname: Rosenthal
mesh_terms: D055396:Bone Morphogenetic Protein 2 / Q000627:therapeutic use*; D001860:Bone Plates; D016025:Bone Transplantation / Q000379:methods / Q000473:pathology; D002294:Carcinoma, Squamous Cell / Q000532:radiotherapy; D015331:Cohort Studies; D020878:Device Removal; D005260:Female; D005500:Follow-Up Studies; D058752:Free Tissue Flaps; D006258:Head and Neck Neoplasms / Q000532:radiotherapy; D006801:Humans; D008297:Male; D008334:Mandible / Q000601:surgery; D008336:Mandibular Diseases / Q000601:surgery*; D008875:Middle Aged; D010025:Osteoradionecrosis / Q000601:surgery*; D010027:Osteotomy / Q000295:instrumentation / Q000379:methods; D011183:Postoperative Complications; D011994:Recombinant Proteins / Q000627:therapeutic use; D019651:Plastic Surgery Procedures / Q000379:methods*; D012189:Retrospective Studies; D016038:Skin Transplantation / Q000379:methods; D013529:Surgical Wound Dehiscence / Q000209:etiology; D013530:Surgical Wound Infection / Q000209:etiology; D016212:Transforming Growth Factor beta / Q000627:therapeutic use*; D016896:Treatment Outcome; D014945:Wound Healing / Q000187:drug effects
chemical_list: D055396:Bone Morphogenetic Protein 2; D011994:Recombinant Proteins; D016212:Transforming Growth Factor beta; C499469:recombinant human bone morphogenetic protein-2