Free Flap Reconstruction for Osteoradionecrosis of the Jaws--outcomes and Predictive Factors for Success

Background: The purpose of this study was to determine factors to predict the success of free flap surgery in the treatment of osteoradionecrosis (ORN).

Methods: Univariate analysis of overall and flap complications was performed. The effect of time to ORN, and the time interval between ORN to reconstruction was evaluated.

Results: Fifty-five flaps on 53 patients for ORN were done with a 90% resolution rate. Univariate parameter analysis was significant for infield mandibulotomy. An increased time interval from radiation therapy (XRT) to ORN development significantly predicted for flap-specific complications and flap loss (p < .05). Increased time from ORN diagnosis to flap surgery resulted in greater length of bone involvement (p = .01). Anastomotic complications occurred in 13 cases resulting in 7 complete flap losses.

Conclusion: An increased risk of complication was encountered with greater time from XRT to ORN. Thus, in patients developing ORN long after treatment, surgery should be accordingly more aggressive.