Osteomyocutaneous Free Fibula Flap Prevents Osteoradionecrosis and Osteomyelitis in Head and Neck Cancer Reconstruction

Kuan-Ying Wang; Wen-Chung Liu; Chun-Feng Chen; Lee-Wei Chen; Hung-Chi Chen; Kuo-Chung Yang

doi:10.1055/s-0040-1722647

Journal of Reconstructive Microsurgery, Inhaltsverzeichnis

J Reconstr Microsurg 2021; 37(06): 524-529
DOI: 10.1055/s-0040-1722647

Original Article

Osteomyocutaneous Free Fibula Flap Prevents Osteoradionecrosis and Osteomyelitis in Head and Neck Cancer Reconstruction

Kuan-Ying Wang

¹Division of Plastic and Reconstructive Surgery, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan, Republic of China

²Division of Plastic Surgery and Reconstructive Surgery, Chuanghua Christian Hospital, Chuanghua, Taiwan, Republic of China

³School of Medicine, National Yang-Ming University, Taipei, Taiwan, Republic of China

,

Wen-Chung Liu

¹Division of Plastic and Reconstructive Surgery, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan, Republic of China

³School of Medicine, National Yang-Ming University, Taipei, Taiwan, Republic of China

⁴School of Medicine, National Defense Medical Center, Taipei, Taiwan, Republic of China

,

Chun-Feng Chen

⁵Department of Oromaxillofacial Surgery, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan, Republic of China

⁶Dental Laboratory Technology, Shu Zen College of Medicine and Management, Kaohsiung, Taiwan, Republic of China

,

Lee-Wei Chen

¹Division of Plastic and Reconstructive Surgery, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan, Republic of China

³School of Medicine, National Yang-Ming University, Taipei, Taiwan, Republic of China

,

Hung-Chi Chen

⁷International Medical Service Center of China Medical University Hospital, Taichung City, Taiwan, Republic of China

⁸Department of Plastic Surgery, China Medical University, Taichung City, Taiwan, Republic of China

,

Kuo-Chung Yang

¹Division of Plastic and Reconstructive Surgery, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan, Republic of China

³School of Medicine, National Yang-Ming University, Taipei, Taiwan, Republic of China

⁴School of Medicine, National Defense Medical Center, Taipei, Taiwan, Republic of China

› Institutsangaben

Abstract

Background Osteoradionecrosis (ORN) is one of the most severe complications of free fibula reconstruction after radiotherapy. The gold standard treatment of osteomyelitis involves extensive debridement, antibiotics, and sufficiently vascularized muscle flap coverage for better circulation. Therefore, we hypothesized that free fibula flap with muscle could decrease the risk of ORN.

Methods This study consisted of 85 patients who underwent reconstruction with free fibula flap in head and neck cancer by a single reconstructive surgeon at Kaohsiung Veterans General Hospital over a period of 19 years (1998–2016). Patients with postoperative adjuvant radiotherapy were included in the study and were grouped by either free fibula osteocutaneous flap or free fibula osteomyocutaneous flap (with flexor hallucis longus muscle), and the incidence of ORN was compared.

Results Of the 85 patients, 15 were reconstructed with osteocutaneous fibula flap and 70 were with osteomyocutaneous fibula flap. The rate of ORN or osteomyelitis was significantly lower in the muscle group (18.6%, n = 13/70 vs. 46.7%, n = 7/15, p = 0.020, Chi-square test).

Conclusion Vascularized muscle transfer increases perfusion of surrounding tissues and the bone flap, thereby decreasing the incidence of osteomyelitis or osteonecrosis.

Keywords

head and neck reconstruction - osteoradionecrosis - oropharyngeal cancer

Volltext

Referenzen

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