Comparing the Outcomes of Osteocutaneous Radial Forearm and Fibula Free Flaps in the Reconstruction of Mandibular Osteoradionecrosis.

Autor: Al Afif A; Department of Head and Neck, Plastic and Reconstructive Surgery, Roswell Park Comprehensive Cancer Center, Buffalo, New York, USA., Peña-Garcia A; Department of Otolaryngology-Head and Neck Surgery, University of Alabama at Birmingham, Birmingham, Alabama, USA., Thomas CM; Department of Otolaryngology-Head and Neck Surgery, University of Alabama at Birmingham, Birmingham, Alabama, USA., Kain JJ; Department of Otolaryngology-Head and Neck Surgery, Houston Methodist Hospital, Houston, Texas, USA., Grayson JW; Department of Otolaryngology-Head and Neck Surgery, University of Alabama at Birmingham, Birmingham, Alabama, USA., Tipirneni KE; Department of Otolaryngology-Head and Communication Sciences, State University of New York Medical University, Syracuse, New York, USA., Moore LS; Department of Otolaryngology-Head and Neck Surgery, Stanford University, Stanford, California, USA., Jeyarajan H; Department of Otolaryngology-Head and Neck Surgery, University of Alabama at Birmingham, Birmingham, Alabama, USA., Sweeny L; Department of Otolaryngology-Head and Neck Surgery, University of Miami, Miami, Florida, USA., Clemons L; Department of Otolaryngology-Head and Neck Surgery, University of Alabama at Birmingham, Birmingham, Alabama, USA., Rosenthal EL; Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University, Nashville, Tennessee, USA., Greene BJ; Department of Otolaryngology-Head and Neck Surgery, University of Alabama at Birmingham, Birmingham, Alabama, USA.
Jazyk: angličtina
Zdroj: Microsurgery [Microsurgery] 2024 Oct; Vol. 44 (7), pp. e31243.
DOI: 10.1002/micr.31243
Abstrakt: Background: This study compares the outcomes of osteocutaneous radial forearm free flap (OC-RFFF) and fibula free flap (FFF) reconstruction of mandibular osteoradionecrosis (ORN).
Methods: Retrospective review of patients undergoing OC-RFFF/FFF reconstruction for mandible ORN between 2005 and 2020 at a tertiary center. Patient characteristics, postoperative complications, and functional outcomes were evaluated using chi-squared and logistic regression analysis.
Results: Fifty-six patients were included (OC-RFFF: 38; FFF: 18). Significantly more OC-RFFF patients had lateral mandible defects (94% vs. 61%, p = 0.0014). There were significantly more patients with exposed intraoral bone in the OC-RFFF group (23% vs. 0% p = 0.02), but no significant differences in hardware complications or flap failure. Donor site partial skin graft loss was more common in the FFF group (22% vs. 2.6%, p = 0.016), but no other significant differences in donor site morbidity were seen. Bivariable analysis showed no impact of flap type, tobacco/alcohol use, diabetes, or hypothyroidism on postoperative complications. Sixty percent of OC-RFFF, and 67% of FFF, patients resumed an oral diet after surgery. Oral diet was not impacted by flap type (OR = 0.769, 95% CI = 0.201-2.706, p = 0.688).
Conclusion: The OC-RFFF is an acceptable option in the reconstruction of ORN involving the lateral mandible, though there is increased risk of bone exposure. These findings can help guide surgeon selection of microvascular free flap donor sites and appropriate patient counseling.
(© 2024 Wiley Periodicals LLC.)
Databáze: MEDLINE
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