title: Can we predict which patients are likely to develop severe complications following reconstruction for osteoradionecrosis?
abstract: High morbidity has been reported for free vascularised reconstruction for osteoradionecrosis (ORN) and there are no apparent risk factors. A single nucleotide polymorphism in the transforming growth factor beta 1 gene (TGF-β1) has been implicated in the cause of ORN and may also predict these complications. We studied a series of 30 consecutive patients who had had reconstruction for severe ORN with free tissue transfer in relation to their outcomes and complications for a number of risk factors including TFG-β1 genotype, age, sex, comorbidities, site and stage of tumour, type of initial operation, and dose of radiotherapy or chemoradiotherapy. Two patients died and 2 flaps failed. Using the Clavien-Dindo classification, 16 patients developed grade III complications and 6 grade II. Median (IQR) duration of inpatient stay was 19.5 (12-25) days and the median (IQR) duration of outpatient treatment was 6 (4-11) weeks. No specific risk factors for postoperative complications were identified. In view of the severity and unpredictability of the complications, careful preoperative counselling of patients is essential.
authors.affiliation: Head and Neck Unit, Guy's and St. Thomas' Hospital NHS Foundation Trust, London, United Kingdom. Electronic address: Andrew.lyons@gstt.nhs.uk.
authors.forename: Andrew J
authors.initials: AJ
authors.lastname: Lyons
authors.forename: Iain
authors.initials: I
authors.lastname: Nixon
authors.forename: Dionyssia
authors.initials: D
authors.lastname: Papadopoulou
authors.forename: Siobhan
authors.initials: S
authors.lastname: Crichton
mesh_terms: D000367:Age Factors; D000368:Aged; D000553:Ambulatory Care; D059248:Chemoradiotherapy; D005260:Female; D005544:Forecasting; D058752:Free Tissue Flaps / Q000098:blood supply / Q000637:transplantation; D005838:Genotype; D006760:Hospitalization; D006801:Humans; D007571:Jaw Diseases / Q000601:surgery*; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D009062:Mouth Neoplasms / Q000532:radiotherapy / Q000601:surgery; D009367:Neoplasm Staging; D010025:Osteoradionecrosis / Q000601:surgery*; D020641:Polymorphism, Single Nucleotide / Q000235:genetics; D011183:Postoperative Complications; D011879:Radiotherapy Dosage; D019651:Plastic Surgery Procedures / Q000379:methods*; D012086:Reoperation; D012307:Risk Factors; D012737:Sex Factors; D013941:Thymine; D053773:Transforming Growth Factor beta1 / Q000235:genetics; D016896:Treatment Outcome
chemical_list: D053773:Transforming Growth Factor beta1; D013941:Thymine
keywords: Complications; Osteoradionecrosis; Reconstruction