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Lessons learned from reconstructing advanced osteoradionecrosis with free vascularized flaps: a retrospective study

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European Journal of Plastic Surgery Aims and scope Submit manuscript

Abstract

Background

At present, there is no universally accepted standard of care for osteoradionecrosis (ORN), and comprehensive clinical guidelines remain absent. The primary objective of this study is to offer insights into the effectiveness and safety of microvascular reconstruction approach in patients with ORN.

Methods

A retrospective analysis was conducted on all patients who underwent free flap reconstruction following a diagnosis of ORN by the senior author, from 2005 to 2022. Data regarding the patient’s demographics, comorbidities, previous treatments, ORN classification, postoperative complications, and therapeutic outcome were collected.

Results

Fifty-three free flaps were carried out in a cohort of 48 patients. One maxilla ORN and 42 mandible ORN were treated. The most common flap chosen was free fibula flap. The only risk factor that was statistically significant for major complications was previous neck dissection. Concerning complications after discharge, 41 patients had follow-up with an average follow-up duration of 60 months. Exposure of osteosynthesis material and fistula were the most common long-term complications that required return to the OR. Only 11.36% had recurrence of ORN.

Conclusions

The iliac crest flap represents a valuable option for mandible reconstruction. However, this preference does not extend to ORN; fibula flap remains the optimal choice. It is worth noting that flap and complication rates are notably higher in ORN. Patients with a history of neck dissection are at a heightened risk of complications. Our study demonstrates a reassuring outcome as ORN recurrence occurred approximately in only one out of eight patients.

Level of evidence: Level IV, risk/prognostic.

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Data Availability

The data support the findings of this study are available from the corresponding author: Larissa Lanzaro, upon reasonable request.

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Funding

The authors declare that no funds, grants, or other support was received during the preparation of this manuscript.

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Authors and Affiliations

  1. Plastic Reconstructive Craniomaxillofacial Hand Microsurgical Unit, Centro Hospitalar Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal

    Larissa Lanzaro, Leonor Caixeiro, Carolina Chaves, Bruno Morgado, Horácio Zenha & Horácio Costa

  2. Aveiro University, Aveiro, Portugal

    Horácio Zenha & Horácio Costa

  3. Algarve University, Algarve, Portugal

    Bruno Morgado

  4. Hospital Lusíadas, Porto, Portugal

    Cristina Pinto

Authors
  1. Larissa Lanzaro
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  2. Leonor Caixeiro
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  3. Carolina Chaves
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  4. Bruno Morgado
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  5. Cristina Pinto
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  6. Horácio Zenha
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  7. Horácio Costa
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Contributions

All authors contributed to the study conception, design, material preparation, data collection, and analysis. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Larissa Lanzaro.

Ethics declarations

Ethics approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. Approval was granted by the Ethics Committee of Centro Hospitalar Vila Nova de Gaia/Espinho - CES 39/2022.

Consent to participate

Consent was obtained from all individuals participants who participated in the study. 

Competing interests

Larissa Lanzaro, Leonor Caixeiro, Carolina Chaves, Bruno Morgado, Cristina Pinto, Horácio Zenha, and Horácio Costa declare no conflict of interest.

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Lanzaro, L., Caixeiro, L., Chaves, C. et al. Lessons learned from reconstructing advanced osteoradionecrosis with free vascularized flaps: a retrospective study. Eur J Plast Surg 47, 34 (2024). https://doi.org/10.1007/s00238-024-02170-9

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  • DOI: https://doi.org/10.1007/s00238-024-02170-9

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