title: Outcomes of microvascular free flap reconstruction for mandibular osteoradionecrosis: A systematic review.
abstract: BACKGROUND
  Osteoradionecrosis of the mandible is a devastating complication of radiotherapy in patients with head and neck cancer. Many cases present at a late stage, from months to years following completion of radiation therapy. When medical treatment fails, surgery may be required with a variety of free flaps available for microvascular reconstructive techniques.
  
  
  OBJECTIVE
  To conduct a systematic review of the literature investigating the outcomes of free flap reconstruction of the jaw in mandibular osteoradionecrosis and determine the failure rates of different flap tissue.
  
  
  METHODS
  A systematic literature search was performed using Medline (Ovid) Pubmed and Embase databases and Google Scholar. Primary outcome measures were flap failures and complications, with donor site complications representing the secondary outcome measure. Analysis of pooled outcomes was undertaken for different flaps.
  
  
  RESULTS
  333 articles were identified and 15 articles met the final inclusion criteria, detailing 368 primary free tissue flap transfers. There was a flap failure rate of 9.8%. There were 146 post-operative complications (39.7%), the most common being fistula formation (8.4%), hardware plate exposure (7.1%) and flap wound infections (6.5%).
  
  
  CONCLUSIONS
  The fibula is the workhorse free flap for reconstruction in mandibular osteoradionecrosis. Evidence to date is largely limited with the need for larger powered multi-institutional prospective studies to determine the ideal flap donor tissue and evaluate patient and treatment predictors of free flap outcomes in order to tailor the best patient-based surgical approach for mandibular osteoradionecrosis.
authors.affiliation: Department of Otolaryngology, Head and Neck Surgery, Nepean Hospital, Sydney, Australia.
authors.forename: Migie
authors.initials: M
authors.lastname: Lee
authors.affiliation: University of Sydney, Australia. Electronic address: drronaldchin@gmail.com.
authors.forename: Ronald Y
authors.initials: RY
authors.lastname: Chin
authors.affiliation: The Whiteley-Martin Research Centre, The University of Sydney, Nepean Hospital, Sydney, Australia.
authors.forename: Guy D
authors.initials: GD
authors.lastname: Eslick
authors.affiliation: Department of Otolaryngology, Head and Neck Surgery, Nepean Hospital, Sydney, Australia.
authors.forename: Niranjan
authors.initials: N
authors.lastname: Sritharan
authors.affiliation: University of Sydney, Australia.
authors.forename: Suchitra
authors.initials: S
authors.lastname: Paramaesvaran
mesh_terms: D016371:Cranial Irradiation / Q000009:adverse effects; D058752:Free Tissue Flaps / Q000601:surgery*; D006801:Humans; D010025:Osteoradionecrosis / Q000601:surgery*; D011446:Prospective Studies; D019651:Plastic Surgery Procedures; D012189:Retrospective Studies; D016896:Treatment Outcome
keywords: Free Tissue Flaps; Head and neck neoplasms; Mandible; Osteoradionecrosis; Surgical flaps