title: Microsurgical reconstruction after bisphosphonate-related osteonecrosis of the jaw: our experience with fibula free flap.
abstract: BACKGROUND
  Bisphosphonate-related osteonecrosis of the jaws (BRONJ) is the most serious complication of bisphosphonates therapy. Despite that several treatment modalities have been described, aggressive surgical treatment approach with wide bone resection and vascularized microsurgical reconstruction are controversial. The aim of this study was to evaluate the clinical outcome of 8 new cases of BRONJ treated with radical resection and mandibular reconstruction with fibula free flap, to enforce the evidence about the reliability of this treatment option.
  
  
  METHODS
  Retrospective data of 8 patients with BRONJ who underwent segmental mandibulectomy and reconstruction with osteocutaneous fibula free flap from January 2004 to January 2008 were collected, including 6 patients with stage 3 BRONJ and 2 patients with recalcitrant stage 2 BRONJ.
  
  
  RESULTS
  All patients were white, with a mean age of 64.7 years (range, 53-77 y), and 62.5% were women. All bisphosphonates were administered intravenously, and all patients had mandibular localization. The mean period of follow-up was 28.9 months. No flap loss or minor complications and no BRONJ recurrence were observed. All patients were able to ambulate pain-free.
  
  
  CONCLUSIONS
  Despite initial concerns regarding reliability of the mandibular free-flap reconstruction after BRONJ, this method seems to be a safe and feasible option in cancer patients with reasonable life expectancy, with complete BRONJ resolution and life quality improvement. Our findings confirm data previously published by other authors, without complication and with a much longer median follow-up time.
authors.affiliation: From the *Maxillofacial Surgery Unit, CTO, Careggi University Hospital, Florence, Italy; †Department of Plastic and Reconstructive Surgery, Marche Polytechnic University Medical School, Regional Hospital, Ancona, Italy; ‡Plastic and Reconstructive Surgery Unit, Hospital of Pisa, Pisa, Italy; and §Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Spinelli
authors.forename: Matteo
authors.initials: M
authors.lastname: Torresetti
authors.forename: Davide
authors.initials: D
authors.lastname: Lazzeri
authors.forename: Yi Xin
authors.initials: YX
authors.lastname: Zhang
authors.forename: Francesco
authors.initials: F
authors.lastname: Arcuri
authors.forename: Tommaso
authors.initials: T
authors.lastname: Agostini
authors.forename: Luca
authors.initials: L
authors.lastname: Grassetti
mesh_terms: D000368:Aged; D059266:Bisphosphonate-Associated Osteonecrosis of the Jaw / Q000601:surgery*; D016025:Bone Transplantation / Q000379:methods*; D005240:Feasibility Studies; D005260:Female; D058752:Free Tissue Flaps / Q000637:transplantation*; D006801:Humans; D008297:Male; D063168:Mandibular Osteotomy / Q000379:methods*; D063175:Mandibular Reconstruction / Q000379:methods*; D008866:Microsurgery / Q000379:methods*; D008875:Middle Aged; D012189:Retrospective Studies