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

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.

Rates of osteoradionecrosis in resected oral cavity cancer reconstructed with free tissue transfer in the intensity‐modulated radiotherapy era

“…Eight (57%) of 14 patients with ORN were diagnosed at 5 years or longer after IMRT completion. Despite high reported rates of ORN in two prior studies specifically evaluating fibular free flaps (34%-47%), 18,19 the present findings found that mandibular reconstruction did not escalate risk of ORN. The incidence of ORN in reconstructed mandibles was 7.9%, which was slightly lower than that of native mandibles (9.4%), and the difference was not statistically significant.…”

“…All patients underwent free flap surgery, with reconstructed mandibles defined by those who had fibular free flap, and native mandibles defined by those who had any non-osseous free tissue transfer. The overall incidence of Grade ≥2 ORN for the cohort was 9.0%, which is substantially lower than two studies specifically analyzing fibular flap reconstruction, 18,19 but consistent with those reported by other prior studies. 6,9,[24][25][26][27][28][29] The incidence of ORN between reconstructed and native mandible cohorts was not significantly different (7.9% vs. 9.4%, respectively).…”

“…18 Wang et al reported a 47% incidence of ORN in 15 patients treated with osteocutaneous fibula flap who underwent postoperative RT. 19 The incidence of ORN in reconstructed versus native mandibles and the identification of risk factors have not been formally evaluated. Prior studies have lacked a direct comparison group.…”

“…Among 74 patients with head and neck cancer undergoing osseous free flaps and postoperative RT not limited to IMRT, an ORN rate of 34% was reported 18 . Wang et al reported a 47% incidence of ORN in 15 patients treated with osteocutaneous fibula flap who underwent postoperative RT 19 …”

Outcomes of Revision Hip Replacement After Resection Arthroplasty With a Non-Free Muscle Flap Transfer for Difficult-To-Treat Periprosthetic Infection

“…Эффективность двухэтапной методики с установкой антимикробного спейсера при ППИ, обусловленной ТДЭ-возбудителями, по нашим данным и публикациям зарубежных авторов, крайне низкая, и операцией выбора в таких случаях может быть резекционная артропластика с несвободной пересадкой мышечного лоскута [6,7,8,9,10]. Несмотря на то, что уже продолжительное время радикальная хирургическая обработка с пересадкой мышечного лоскута, которая характеризуется высокой эффективностью в отношении купирования инфекционного процесса, является золотым стандартом лечения хронического остеомиелита любой локализации, применительно к тазобед ренному суставу (ТБС) данную методику используют крайне редко [11,12]. По-видимому, это обусловлено не только отсутствием у большинства ортопедов технических навыков и умения выполнить пластический этап операции, но и, как показывают немногочисленные публикации, прогнозируемо низким функциональным результатом резекционной артропластики [13,14,15].…”