title: Free flap reconstruction for patients with bisphosphonate related osteonecrosis of the jaws after mandibulectomy.
abstract: BACKGROUND
  Bisphosphonate related osteonecrosis of the jaws (BRONJ) is a recognised unwanted effect of these drugs which affect bone remodelling. Treatment options range from conservative approaches through local bone debridement to free flap reconstruction following segmental resection. This current study aims to evaluate clinical outcomes after microvascular tissue transfer in BRONJ patients.
  
  
  METHODS
  A total of 212 BRONJ patients were included in this prospective investigation. Those who met defined inclusion criteria and received a surgical intervention were reviewed regularly during a follow-up period of at least 6 months.
  
  
  RESULTS
  Twenty-five patients (11.8%) received free flap reconstructions. A mean of 2.12 local debridements were performed before microvascular tissue transfer. A mean of 29.25% showed BRONJ recurrence after minimalist surgical intervention, compared to significantly less in patients after resection and free flap reconstruction. The postoperative fistula rate was significantly higher in patients, who received mucoperiosteal flaps.
  
  
  CONCLUSIONS
  This study underlines the importance and effectiveness radical resection and free flap reconstruction in the complex and challenging surgical treatment of BRONJ patients in a large patient cohort study. Nevertheless, all patients received radical intervention after failure of minimally invasive treatment. An individualized analysis and planning is necessary to identify appropriate patients for free flap reconstructions.
authors.affiliation: Department of Oral and Maxillofacial Surgery, Technische Universität München, Klinikum Rechts der Isar, Germany. Electronic address: th.mucke@gmx.de.
authors.forename: Thomas
authors.initials: T
authors.lastname: Mücke
authors.affiliation: Department of Oral and Maxillofacial Surgery, Technische Universität München, Klinikum Rechts der Isar, Germany.
authors.forename: Maximilian
authors.initials: M
authors.lastname: Jung
authors.affiliation: Department of Oral and Maxillofacial Surgery, Technische Universität München, Klinikum Rechts der Isar, Germany.
authors.forename: Steffen
authors.initials: S
authors.lastname: Koerdt
authors.affiliation: Department of Oral and Maxillofacial Surgery, Technische Universität München, Klinikum Rechts der Isar, Germany.
authors.forename: David A
authors.initials: DA
authors.lastname: Mitchell
authors.affiliation: Department of Oral and Maxillofacial Surgery, Technische Universität München, Klinikum Rechts der Isar, Germany.
authors.forename: Denys
authors.initials: D
authors.lastname: Loeffelbein
authors.affiliation: Department of Oral and Maxillofacial Surgery, Technische Universität München, Klinikum Rechts der Isar, Germany.
authors.forename: Marco R
authors.initials: MR
authors.lastname: Kesting
mesh_terms: D059266:Bisphosphonate-Associated Osteonecrosis of the Jaw / Q000601:surgery*; D004164:Diphosphonates / Q000009:adverse effects; D058752:Free Tissue Flaps; D006801:Humans; D063168:Mandibular Osteotomy / Q000379:methods*; D011446:Prospective Studies; D019651:Plastic Surgery Procedures / Q000379:methods*; D016896:Treatment Outcome
chemical_list: D004164:Diphosphonates
keywords: Bisphosphonates; Jaws; Microvascular free flap; Osteonecrosis; Recurrence; Treatment outcome