title: Outcomes of osseous free flap reconstruction in stage III bisphosphonate-related osteonecrosis of the jaw: systematic review and a new case series.
abstract: BACKGROUND
  There is currently no gold standard for the treatment of Stage III bisphosphonate-related osteonecrosis of the jaw (BRONJ). The question remains whether osseous reconstruction can offer an additional gain in outcome given the theoretical risk of non-union at the resection margins and recurrence in the osseous free flap. The objective was to conduct a systematic review of articles describing outcomes of osseous microsurgical reconstruction in cases of BRONJ with a minimum follow-up of 12 months, and to present the long-term outcomes of a new case series of three patients.
  
  
  METHODS
  A multi-database QUORUM-based single-reviewer systematic review identified eight papers that fulfilled the selection criteria. There are only case series and case reports available (Level 4 of the Oxford Evidence-based medicine scale). A total of 31 patients were analysed including the cases described in this article.
  
  
  CONCLUSIONS
  The limited overall rate of non-union at the resection margins and the 6.5% recurrence rate of BRONJ in the transplant counters the theoretical objections and advocates for considering osseous free flap reconstruction in the treatment of refractory BRONJ Stage III lesions. However, additional data derived from larger case series or case-control studies are imperative to support this hypothesis.
authors.affiliation: Dienst Mond-, Kaak- en Aangezichtschirurgie (Head: Maurice Y. Mommaerts), European Face Center, Universitair Ziekenhuis Brussel, Laarbeeklaan 101, 1090 Brussels, Belgium. Electronic address: hermanjunior.vercruysse@uzbrussel.be.
authors.forename: Herman
authors.initials: H
authors.lastname: Vercruysse
authors.affiliation: Dienst Mond-, Kaak- en Aangezichtschirurgie (Head: Herman Van den Eynde), OLV Ziekenhuis, Aalst, Belgium.
authors.forename: Tom de
authors.initials: Td
authors.lastname: Backer
authors.affiliation: Dienst Mond-, Kaak- en Aangezichtschirurgie (Head: Maurice Y. Mommaerts), European Face Center, Universitair Ziekenhuis Brussel, Laarbeeklaan 101, 1090 Brussels, Belgium.
authors.forename: Maurice Y
authors.initials: MY
authors.lastname: Mommaerts
mesh_terms: D000368:Aged; D059266:Bisphosphonate-Associated Osteonecrosis of the Jaw / Q000145:classification / Q000601:surgery*; D016025:Bone Transplantation / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D005598:Fractures, Spontaneous / Q000601:surgery; D058752:Free Tissue Flaps / Q000637:transplantation*; D006801:Humans; D007085:Ilium / Q000098:blood supply / Q000601:surgery; D008137:Longitudinal Studies; D008336:Mandibular Diseases / Q000145:classification / Q000601:surgery*; D008337:Mandibular Fractures / Q000601:surgery; D008866:Microsurgery / Q000379:methods; D008875:Middle Aged; D064827:Myocutaneous Flap / Q000098:blood supply / Q000637:transplantation; D010014:Osteolysis / Q000601:surgery; D019651:Plastic Surgery Procedures / Q000379:methods*; D060053:Transplant Donor Site / Q000098:blood supply / Q000601:surgery; D016896:Treatment Outcome
keywords: Bisphosphonates; Fibula free flap; Iliac crest free flap; Osteonecrosis