title: Comparison of complications in free flap reconstruction for osteoradionecrosis in patients with or without hyperbaric oxygen therapy.
abstract: BACKGROUND
  Hyperbaric oxygen (HBO) therapy induces native tissue oxygenation. The hypothesis was patients with mandibular osteoradionecrosis (ORN) and a history of HBO therapy would have less free flap reconstruction complications than patients without HBO therapy.
  
  
  METHODS
  We conducted a multisite retrospective review involving radical debridement and free flap reconstruction for ORN between January 1, 1995 and June 30, 2011. Patients were stratified based on receiving prior HBO therapy or not.
  
  
  RESULTS
  Thirty-nine of 89 patients (43.8%) had HBO therapy whereas 50 of 89 (56.2%) did not. The HBO therapy group had significantly less patients with diabetes. There was no statistical difference in overall complication in patients between groups (p = .5478). However, there was marginal significance of increased infections in the patients with a history of HBO therapy (p = .0545).
  
  
  CONCLUSIONS
  Although no significant differences in free flap reconstruction complication rates were observed between these 2 patient cohorts, there was marginal significance of increased infections in the patients with a history of HBO therapy. A prospective multi-institutional randomized study examining issues of infection would address issues inherent in this retrospective study.
authors.affiliation: Division of Otolaryngology-Head and Neck Surgery, Duke University Medical Center Department of Surgery, Durham, North Carolina.
authors.forename: David
authors.initials: D
authors.lastname: Nolen
authors.forename: Steven B
authors.initials: SB
authors.lastname: Cannady
authors.forename: Mark K
authors.initials: MK
authors.lastname: Wax
authors.forename: Joseph
authors.initials: J
authors.lastname: Scharpf
authors.forename: Liana
authors.initials: L
authors.lastname: Puscas
authors.forename: Ramon M
authors.initials: RM
authors.lastname: Esclamado
authors.forename: Michael
authors.initials: M
authors.lastname: Fritz
authors.forename: John
authors.initials: J
authors.lastname: Freiberger
authors.forename: Walter T
authors.initials: WT
authors.lastname: Lee
mesh_terms: D003646:Debridement / Q000009:adverse effects; D005260:Female; D058752:Free Tissue Flaps / Q000009:adverse effects*; D006258:Head and Neck Neoplasms / Q000532:radiotherapy; D006801:Humans; D006931:Hyperbaric Oxygenation; D008297:Male; D008336:Mandibular Diseases / Q000209:etiology / Q000628:therapy*; D010025:Osteoradionecrosis / Q000209:etiology / Q000628:therapy*; D019651:Plastic Surgery Procedures / Q000009:adverse effects*; D012189:Retrospective Studies; D013530:Surgical Wound Infection / Q000453:epidemiology*; D016896:Treatment Outcome; D014945:Wound Healing
keywords: free flap reconstruction; hyperbaric oxygen; osteoradionecrosis; radiation complications; surgical complications