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A Journal on Otorhinolaryngology, Head and Neck Surgery,
Plastic Reconstructive Surgery, Otoneurosurgery
Indexed/Abstracted in: EMBASE, Scopus
Otorinolaringologia 1998 September;48(3):135-43
Mandibular osteoradionecrosis results. Reconstruction with revascularized osseous free flaps
Ferrari S., Bianchi B., Sesenna E.
Divisione di Chirurgia Maxillo-Facciale - Parma
Head and neck cancer patients requiring bone and soft tissues reconstruction in a previously radiated field present one of the most challenging problems to a reconstructive surgeon. These include the presence of soft tissue contracture that displace the mandibular segment in malposition, extensive fibrosis of the remaining muscles of mastication and soft tissue deficiencies.
Oral anesthesia and xerostomia may also inhibit the patients’ level of functioning. The local tissues are poorly vascularized and the limited ability of the previously radiated mandible to accept osteointegrated implants may preclude functional mastication. Personal experience with five osteocutaneous fibular free flaps for mandibular reconstruction in osteoradionecrosis results patients at the Maxillo-Facial Department of Parma from February 1996 to May 1997 is presented. Four of five flaps survived completely. In one flap the postoperative course was complicated by skin necrosis. All of bone junction developed a solid bone union despite the mandible having had a full therapeutic dose of preoperative radiation. The advantage of using vascularized bone containing free flap in this setting are numerous. Unlike non vascularized alternatives, vascularized bone allows reliable healing to adjoining mandibular segment uncontaminated and compromised tissue beds. Vascularized bone containing free flap can provide various amount of vascularized skin, subcutaneous fat and muscle for more precise structural and functional restoration of intraoral soft tissues and cutaneous defect.