Free flap reconstruction of osteoradionecrosis of the mandible: a 10-year review and defect classification.

BACKGROUND The purpose of this study was to evaluate outcomes of free flap reconstruction for advanced osteoradionecrosis (ORN) defects and develop an algorithm to guide surgical planning. METHODS All cases involving free flap reconstruction for ORN of the mandible between 1998 and 2008 were reviewed. A defect classification scheme was developed. Flap selection and outcomes were analyzed and evaluated by defect type. RESULTS Seventy-five free flaps and 13 pedicle flaps were performed in 63 patients. Total flap loss was 5%. Overall surgical complication was 32%. Complication rates were higher with bone flaps than with soft tissue flaps (p = .018). A full oral diet was tolerated in 57% of patients, whereas 26% required partial tube feeding, and 16% were tube-feeding dependent. CONCLUSION Free flap reconstruction of advanced ORN defects can be safely performed in a variety of flap configurations with good outcomes. The classification scheme may assist in flap selection.