title: Minimizing osteoradionecrosis after mandibular reconstruction and radiation in advanced head and neck cancer patients.
abstract: BACKGROUND
  Osteoradionecrosis may develop on the residual mandible or reconstructed fibula because of inadequate soft tissue coverage and compromised tissue perfusion post mandibular reconstruction, and radiation. This study was to investigate the incidence of osteoradionecrosis following class III mandibular defect reconstructions with an OPAC flap versus a fibula OSC flap.
  
  
  METHODS
  A retrospective review of a consecutive series of mandibular reconstructions between 1999 and 2010 was performed. Mandibular defects and corresponding flap types were analyzed with emphasis on outcome, complications, and rates of osteoradionecrosis among the two subgroups.
  
  
  RESULTS
  A total of 121 fibula flaps were performed, consisting of 53 OPAC and 68 fibula OSC flaps. Complications trended higher for OPAC flaps in partial and total flap loss rates as well as venous congestion when compared with the OSC flap cohort. The OPAC group had statistically significant lower rates of osteoradionecrosis and plate exposure than the OSC group (P = 0.04).
  
  
  CONCLUSIONS
  The OPAC flap may be preferable to fibula OSC flap in mandibular reconstruction given its lower rates of osteoradionecrosis and plate exposure. This flap type may be the flap of choice for class III defects where additional vascularized tissue may be critical for addressing significant soft tissue deficiency. J. Surg. Oncol. 2016;114:399-404. © 2016 Wiley Periodicals, Inc.
authors.affiliation: Division of Reconstructive Microsurgery, Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Taoyuan, Taiwan.|Department of Hand, Plastic, and Reconstructive Surgery, BG-Center Ludwigshafen, University of Heidelberg, Ludwigshafen, Germany.
authors.forename: Emre
authors.initials: E
authors.lastname: Gazyakan
authors.affiliation: Division of Reconstructive Microsurgery, Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Taoyuan, Taiwan.|Center for Tissue Engineering, Chang Gung Memorial Hospital, Taoyuan, Taiwan.
authors.forename: Chih-Wei
authors.initials: CW
authors.lastname: Wu
authors.affiliation: Division of Reconstructive Microsurgery, Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Taoyuan, Taiwan.|Center for Tissue Engineering, Chang Gung Memorial Hospital, Taoyuan, Taiwan.
authors.forename: Jung-Ju
authors.initials: JJ
authors.lastname: Huang
authors.affiliation: Division of Reconstructive Microsurgery, Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Taoyuan, Taiwan.|Department of Plastic, Reconstructive, Aesthetic, and Hand Surgery, Medical Center Kassel, Kassel, Germany.
authors.forename: Holger
authors.initials: H
authors.lastname: Engel
authors.affiliation: Division of Reconstructive Microsurgery, Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Taoyuan, Taiwan.|Department of Plastic and Reconstructive Surgery, Ohio State University Wexner Medical Center, Columbus, Ohio.
authors.forename: Ian Lee
authors.initials: IL
authors.lastname: Valerio
authors.affiliation: Division of Reconstructive Microsurgery, Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Taoyuan, Taiwan.|Center for Tissue Engineering, Chang Gung Memorial Hospital, Taoyuan, Taiwan.
authors.forename: Ming-Huei
authors.initials: MH
authors.lastname: Cheng
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005360:Fibula / Q000637:transplantation; D006258:Head and Neck Neoplasms / Q000532:radiotherapy*; D006801:Humans; D008297:Male; D063175:Mandibular Reconstruction / Q000379:methods*; D008875:Middle Aged; D010025:Osteoradionecrosis / Q000209:etiology*; D012189:Retrospective Studies; D013524:Surgical Flaps
keywords: fibula flap; mandible reconstruction; osteoradionecrosis; peroneal artery perforator flap; plate exposure