Abstract：
BACKGROUND: Osteoradionecrosis (ORN) of the mandible is an unfortunate potential sequela of radiotherapy for head and neck cancer. In advanced cases of ORN, mandibulectomy, and free fibula flap reconstruction are required. We hypothesized that patients undergoing fibula free flap reconstruction and mandibulectomy for ORN pose unique challenges and experience more complications than patients undergoing fibula free flaps after oncologic mandibulectomy.
METHODS: After IRB approval, we created a database of all free fibula flaps for mandible reconstruction from April 2005 through February 2019. Medical records were retrospectively reviewed for patient and surgical characteristics and postoperative outcomes.
RESULTS: Four-hundred seventy-nine patients met the inclusion criteria (168 ORN vs. 311 non-ORN patients). Propensity-matching was performed based on age, BMI, smoking status, preoperative chemotherapy, and virtual surgery planning use, which yielded 159 patients in each group. ORN patients received more double-skin-island fibula flaps than non-OR patients (20.8% vs. 5.7%, p < 0.001). Recipient artery other than the facial artery was utilized more commonly in ORN patients (42.1% vs. 17.0%, p < 0.001). In the unmatched cohort, ORN patients had higher rates of delayed wound healing (26.2% vs. 16.8%, p = 0.01) and surgical site infections (21.4% vs. 13.2%, p = 0.02). Rates of flap loss, return to the operating room, hematoma, operative time, and length of stay were similar between the groups. On logistic regression analysis, osteoradionecrosis was an independent risk factor for delayed wound healing.
CONCLUSIONS: Based on these data, mandibular reconstruction with fibula flaps for osteoradionecrosis appears more complicated than mandible reconstruction following de novo cancer resection. Surgeons should anticipate employing two skin islands for intraoral and extraoral resurfacing, utilizing unconventional recipient vessels, and managing the delayed wound healing that ensues more commonly than non-ORN patients.
METHODS: After IRB approval, we created a database of all free fibula flaps for mandible reconstruction from April 2005 through February 2019. Medical records were retrospectively reviewed for patient and surgical characteristics and postoperative outcomes.
RESULTS: Four-hundred seventy-nine patients met the inclusion criteria (168 ORN vs. 311 non-ORN patients). Propensity-matching was performed based on age, BMI, smoking status, preoperative chemotherapy, and virtual surgery planning use, which yielded 159 patients in each group. ORN patients received more double-skin-island fibula flaps than non-OR patients (20.8% vs. 5.7%, p < 0.001). Recipient artery other than the facial artery was utilized more commonly in ORN patients (42.1% vs. 17.0%, p < 0.001). In the unmatched cohort, ORN patients had higher rates of delayed wound healing (26.2% vs. 16.8%, p = 0.01) and surgical site infections (21.4% vs. 13.2%, p = 0.02). Rates of flap loss, return to the operating room, hematoma, operative time, and length of stay were similar between the groups. On logistic regression analysis, osteoradionecrosis was an independent risk factor for delayed wound healing.
CONCLUSIONS: Based on these data, mandibular reconstruction with fibula flaps for osteoradionecrosis appears more complicated than mandible reconstruction following de novo cancer resection. Surgeons should anticipate employing two skin islands for intraoral and extraoral resurfacing, utilizing unconventional recipient vessels, and managing the delayed wound healing that ensues more commonly than non-ORN patients.
摘要：
背景：下颌骨放射坏死（ORN）是头颈部恶性肿瘤放疗的不幸潜在后遗症。在ORN的晚期病例中，下颌骨切除术,和游离腓骨皮瓣重建是必需的。我们假设接受腓骨游离皮瓣重建和ORN下颌骨切除术的患者比接受肿瘤下颌骨切除术后的腓骨游离皮瓣的患者面临独特的挑战和更多的并发症。
方法：IRB批准后，我们创建了2005年4月至2019年2月用于下颌骨重建的所有游离腓骨皮瓣数据库.对患者和手术特征以及术后结果的病历进行回顾性审查。
结果：四百七十九名患者符合纳入标准（168ORN与311名非ORN患者)。根据年龄进行倾向匹配，BMI,吸烟状况,术前化疗,和虚拟手术计划的使用，每组共159名患者。ORN患者比非OR患者接受更多的双皮肤岛状腓骨皮瓣（20.8％vs.5.7%,p<0.001)。在ORN患者中，面动脉以外的受体动脉更常用(42.1%vs.17.0%,p<0.001)。在无与伦比的队列中，ORN患者伤口延迟愈合率较高(26.2%vs.16.8%,p=0.01）和手术部位感染（21.4%vs.13.2%,p=0.02)。皮瓣损失率,回到手术室,血肿,手术时间,两组之间的住院时间相似。在逻辑回归分析中，骨坏死是伤口延迟愈合的独立危险因素。
结论：根据这些数据，用腓骨皮瓣治疗骨坏死的下颌骨重建比从头切除肿瘤后的下颌骨重建更复杂。外科医生应预期使用两个皮肤岛进行口内和口外表面修复，利用非常规的受体血管，并管理比非ORN患者更常见的延迟伤口愈合。
方法：IRB批准后，我们创建了2005年4月至2019年2月用于下颌骨重建的所有游离腓骨皮瓣数据库.对患者和手术特征以及术后结果的病历进行回顾性审查。
结果：四百七十九名患者符合纳入标准（168ORN与311名非ORN患者)。根据年龄进行倾向匹配，BMI,吸烟状况,术前化疗,和虚拟手术计划的使用，每组共159名患者。ORN患者比非OR患者接受更多的双皮肤岛状腓骨皮瓣（20.8％vs.5.7%,p<0.001)。在ORN患者中，面动脉以外的受体动脉更常用(42.1%vs.17.0%,p<0.001)。在无与伦比的队列中，ORN患者伤口延迟愈合率较高(26.2%vs.16.8%,p=0.01）和手术部位感染（21.4%vs.13.2%,p=0.02)。皮瓣损失率,回到手术室,血肿,手术时间,两组之间的住院时间相似。在逻辑回归分析中，骨坏死是伤口延迟愈合的独立危险因素。
结论：根据这些数据，用腓骨皮瓣治疗骨坏死的下颌骨重建比从头切除肿瘤后的下颌骨重建更复杂。外科医生应预期使用两个皮肤岛进行口内和口外表面修复，利用非常规的受体血管，并管理比非ORN患者更常见的延迟伤口愈合。
