Reconstruction for osteoradionecrosis of the mandible: Superiority of free iliac bone flap to fibula flap in postoperative infection and healing

Shih Heng Chen, Hung Chi Chen, Shyue Yih Horng, Hao Chih Tai, Jung Hsien Hsieh, Eng Kean Yeong, Nai Chen Cheng, Thomas Mon Hsian Hsieh, Hsiung Fei Chien, Yueh Bih Tang

Research output: Contribution to journalArticle

10 Citations (Scopus)

Abstract

BACKGROUND: Osteoradionecrosis (ORN) of the mandible is not an uncommon complication after radiotherapy for head and neck cancers. Although definitive treatment has been confirmed as radical excision of the necrotic bone with simultaneous vascularized osteocutaneous flap reconstruction, it remains a unique challenge. In this study, we compare our results of reconstruction with free iliac and fibula flaps in flap survival, bony union, and postoperative complications. PATIENTS AND METHODS: From 1986 to 2011, there were 153 mandibular ORN cases in our center that were treated with radical resection of the necrotic bone and reconstruction with either vascularized iliac (n = 108) or fibula flaps (n = 45). Data collected for analysis included patient demographics, flap survival rate, postoperative infection rate, nonunion/malunion rate, mean hospital stay, and antibiotics use. RESULTS: All patients healed eventually without recurrence of ORN. However, we observed difference in the complication rate between the iliac flap group and fibula flap group. In the group with iliac flap reconstruction, patients required less days of hospital stay for intravenous antibiotics treatment postoperatively. The average days required for intravenous antibiotics in the iliac flap group were 10.46 (2.28) versus 16.09 (3.88) days in the fibula group (P < 0.01). In the group with fibula flap reconstruction, 9 (20.0%) patients had subsequent neck infection due to healing problem, compared to 8 (7.4%) patients in the iliac flap group (P = 0.04). In the iliac flap group, the nonunion and malunion rates were 4.6% and 2.8% respectively; whereas in the fibula group, the rates were 15.5% and 6.6%, respectively (P = 0.04 and 0.36, respectively). CONCLUSIONS: For ORN patients, vascularized iliac bone flap provides more reliable results compared to fibula flap. The merits of vascularized iliac flap include the following: (1) its natural curve mimics the shape of mandible and does not need osteotomy; (2) it offers more volume of bone that matches better to the native mandible to allow later osteointegration as well as faster bony union, due to the nature of being a membranous bone; and (3) it carries more abundant soft tissue to obliterate possible dead space. The only disadvantages are short pedicle and requiring special management of skin paddle, which can be overcome by training in microsurgery.

Original languageEnglish
JournalAnnals of Plastic Surgery
Volume73
Issue numberSUPPL.1
DOIs
Publication statusPublished - Jan 1 2014
Externally publishedYes

Fingerprint

Osteoradionecrosis
Fibula
Mandible
Bone and Bones
Infection
Anti-Bacterial Agents
Length of Stay
Microsurgery
Head and Neck Neoplasms
Osteotomy
Neck
Radiotherapy
Survival Rate
Demography
Recurrence
Skin
Survival
Therapeutics

Keywords

  • fibula flap
  • iliac bone flap
  • mandible
  • osteoradionecrosis

ASJC Scopus subject areas

  • Surgery

Cite this

Reconstruction for osteoradionecrosis of the mandible : Superiority of free iliac bone flap to fibula flap in postoperative infection and healing. / Chen, Shih Heng; Chen, Hung Chi; Horng, Shyue Yih; Tai, Hao Chih; Hsieh, Jung Hsien; Yeong, Eng Kean; Cheng, Nai Chen; Hsieh, Thomas Mon Hsian; Chien, Hsiung Fei; Tang, Yueh Bih.

In: Annals of Plastic Surgery, Vol. 73, No. SUPPL.1, 01.01.2014.

Research output: Contribution to journalArticle

Chen, Shih Heng ; Chen, Hung Chi ; Horng, Shyue Yih ; Tai, Hao Chih ; Hsieh, Jung Hsien ; Yeong, Eng Kean ; Cheng, Nai Chen ; Hsieh, Thomas Mon Hsian ; Chien, Hsiung Fei ; Tang, Yueh Bih. / Reconstruction for osteoradionecrosis of the mandible : Superiority of free iliac bone flap to fibula flap in postoperative infection and healing. In: Annals of Plastic Surgery. 2014 ; Vol. 73, No. SUPPL.1.
@article{bf066a2f003342c4b152923e3e31ecc8,
title = "Reconstruction for osteoradionecrosis of the mandible: Superiority of free iliac bone flap to fibula flap in postoperative infection and healing",
abstract = "BACKGROUND: Osteoradionecrosis (ORN) of the mandible is not an uncommon complication after radiotherapy for head and neck cancers. Although definitive treatment has been confirmed as radical excision of the necrotic bone with simultaneous vascularized osteocutaneous flap reconstruction, it remains a unique challenge. In this study, we compare our results of reconstruction with free iliac and fibula flaps in flap survival, bony union, and postoperative complications. PATIENTS AND METHODS: From 1986 to 2011, there were 153 mandibular ORN cases in our center that were treated with radical resection of the necrotic bone and reconstruction with either vascularized iliac (n = 108) or fibula flaps (n = 45). Data collected for analysis included patient demographics, flap survival rate, postoperative infection rate, nonunion/malunion rate, mean hospital stay, and antibiotics use. RESULTS: All patients healed eventually without recurrence of ORN. However, we observed difference in the complication rate between the iliac flap group and fibula flap group. In the group with iliac flap reconstruction, patients required less days of hospital stay for intravenous antibiotics treatment postoperatively. The average days required for intravenous antibiotics in the iliac flap group were 10.46 (2.28) versus 16.09 (3.88) days in the fibula group (P < 0.01). In the group with fibula flap reconstruction, 9 (20.0{\%}) patients had subsequent neck infection due to healing problem, compared to 8 (7.4{\%}) patients in the iliac flap group (P = 0.04). In the iliac flap group, the nonunion and malunion rates were 4.6{\%} and 2.8{\%} respectively; whereas in the fibula group, the rates were 15.5{\%} and 6.6{\%}, respectively (P = 0.04 and 0.36, respectively). CONCLUSIONS: For ORN patients, vascularized iliac bone flap provides more reliable results compared to fibula flap. The merits of vascularized iliac flap include the following: (1) its natural curve mimics the shape of mandible and does not need osteotomy; (2) it offers more volume of bone that matches better to the native mandible to allow later osteointegration as well as faster bony union, due to the nature of being a membranous bone; and (3) it carries more abundant soft tissue to obliterate possible dead space. The only disadvantages are short pedicle and requiring special management of skin paddle, which can be overcome by training in microsurgery.",
keywords = "fibula flap, iliac bone flap, mandible, osteoradionecrosis",
author = "Chen, {Shih Heng} and Chen, {Hung Chi} and Horng, {Shyue Yih} and Tai, {Hao Chih} and Hsieh, {Jung Hsien} and Yeong, {Eng Kean} and Cheng, {Nai Chen} and Hsieh, {Thomas Mon Hsian} and Chien, {Hsiung Fei} and Tang, {Yueh Bih}",
year = "2014",
month = "1",
day = "1",
doi = "10.1097/SAP.0000000000000270",
language = "English",
volume = "73",
journal = "Annals of Plastic Surgery",
issn = "0148-7043",
publisher = "Lippincott Williams and Wilkins",
number = "SUPPL.1",

}

TY - JOUR

T1 - Reconstruction for osteoradionecrosis of the mandible

T2 - Superiority of free iliac bone flap to fibula flap in postoperative infection and healing

AU - Chen, Shih Heng

AU - Chen, Hung Chi

AU - Horng, Shyue Yih

AU - Tai, Hao Chih

AU - Hsieh, Jung Hsien

AU - Yeong, Eng Kean

AU - Cheng, Nai Chen

AU - Hsieh, Thomas Mon Hsian

AU - Chien, Hsiung Fei

AU - Tang, Yueh Bih

PY - 2014/1/1

Y1 - 2014/1/1

N2 - BACKGROUND: Osteoradionecrosis (ORN) of the mandible is not an uncommon complication after radiotherapy for head and neck cancers. Although definitive treatment has been confirmed as radical excision of the necrotic bone with simultaneous vascularized osteocutaneous flap reconstruction, it remains a unique challenge. In this study, we compare our results of reconstruction with free iliac and fibula flaps in flap survival, bony union, and postoperative complications. PATIENTS AND METHODS: From 1986 to 2011, there were 153 mandibular ORN cases in our center that were treated with radical resection of the necrotic bone and reconstruction with either vascularized iliac (n = 108) or fibula flaps (n = 45). Data collected for analysis included patient demographics, flap survival rate, postoperative infection rate, nonunion/malunion rate, mean hospital stay, and antibiotics use. RESULTS: All patients healed eventually without recurrence of ORN. However, we observed difference in the complication rate between the iliac flap group and fibula flap group. In the group with iliac flap reconstruction, patients required less days of hospital stay for intravenous antibiotics treatment postoperatively. The average days required for intravenous antibiotics in the iliac flap group were 10.46 (2.28) versus 16.09 (3.88) days in the fibula group (P < 0.01). In the group with fibula flap reconstruction, 9 (20.0%) patients had subsequent neck infection due to healing problem, compared to 8 (7.4%) patients in the iliac flap group (P = 0.04). In the iliac flap group, the nonunion and malunion rates were 4.6% and 2.8% respectively; whereas in the fibula group, the rates were 15.5% and 6.6%, respectively (P = 0.04 and 0.36, respectively). CONCLUSIONS: For ORN patients, vascularized iliac bone flap provides more reliable results compared to fibula flap. The merits of vascularized iliac flap include the following: (1) its natural curve mimics the shape of mandible and does not need osteotomy; (2) it offers more volume of bone that matches better to the native mandible to allow later osteointegration as well as faster bony union, due to the nature of being a membranous bone; and (3) it carries more abundant soft tissue to obliterate possible dead space. The only disadvantages are short pedicle and requiring special management of skin paddle, which can be overcome by training in microsurgery.

AB - BACKGROUND: Osteoradionecrosis (ORN) of the mandible is not an uncommon complication after radiotherapy for head and neck cancers. Although definitive treatment has been confirmed as radical excision of the necrotic bone with simultaneous vascularized osteocutaneous flap reconstruction, it remains a unique challenge. In this study, we compare our results of reconstruction with free iliac and fibula flaps in flap survival, bony union, and postoperative complications. PATIENTS AND METHODS: From 1986 to 2011, there were 153 mandibular ORN cases in our center that were treated with radical resection of the necrotic bone and reconstruction with either vascularized iliac (n = 108) or fibula flaps (n = 45). Data collected for analysis included patient demographics, flap survival rate, postoperative infection rate, nonunion/malunion rate, mean hospital stay, and antibiotics use. RESULTS: All patients healed eventually without recurrence of ORN. However, we observed difference in the complication rate between the iliac flap group and fibula flap group. In the group with iliac flap reconstruction, patients required less days of hospital stay for intravenous antibiotics treatment postoperatively. The average days required for intravenous antibiotics in the iliac flap group were 10.46 (2.28) versus 16.09 (3.88) days in the fibula group (P < 0.01). In the group with fibula flap reconstruction, 9 (20.0%) patients had subsequent neck infection due to healing problem, compared to 8 (7.4%) patients in the iliac flap group (P = 0.04). In the iliac flap group, the nonunion and malunion rates were 4.6% and 2.8% respectively; whereas in the fibula group, the rates were 15.5% and 6.6%, respectively (P = 0.04 and 0.36, respectively). CONCLUSIONS: For ORN patients, vascularized iliac bone flap provides more reliable results compared to fibula flap. The merits of vascularized iliac flap include the following: (1) its natural curve mimics the shape of mandible and does not need osteotomy; (2) it offers more volume of bone that matches better to the native mandible to allow later osteointegration as well as faster bony union, due to the nature of being a membranous bone; and (3) it carries more abundant soft tissue to obliterate possible dead space. The only disadvantages are short pedicle and requiring special management of skin paddle, which can be overcome by training in microsurgery.

KW - fibula flap

KW - iliac bone flap

KW - mandible

KW - osteoradionecrosis

UR - http://www.scopus.com/inward/record.url?scp=84905977798&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84905977798&partnerID=8YFLogxK

U2 - 10.1097/SAP.0000000000000270

DO - 10.1097/SAP.0000000000000270

M3 - Article

C2 - 25115374

AN - SCOPUS:84905977798

VL - 73

JO - Annals of Plastic Surgery

JF - Annals of Plastic Surgery

SN - 0148-7043

IS - SUPPL.1

ER -