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
1  Division of Plastic and Reconstructive Surgery, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan, Republic of China
2  Division of Plastic Surgery and Reconstructive Surgery, Chuanghua Christian Hospital, Chuanghua, Taiwan, Republic of China
3  School of Medicine, National Yang-Ming University, Taipei, Taiwan, Republic of China
,
Wen-Chung Liu
1  Division of Plastic and Reconstructive Surgery, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan, Republic of China
3  School of Medicine, National Yang-Ming University, Taipei, Taiwan, Republic of China
4  School of Medicine, National Defense Medical Center, Taipei, Taiwan, Republic of China
,
Chun-Feng Chen
5  Department of Oromaxillofacial Surgery, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan, Republic of China
6  Dental Laboratory Technology, Shu Zen College of Medicine and Management, Kaohsiung, Taiwan, Republic of China
,
Lee-Wei Chen
1  Division of Plastic and Reconstructive Surgery, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan, Republic of China
3  School of Medicine, National Yang-Ming University, Taipei, Taiwan, Republic of China
,
Hung-Chi Chen
7  International Medical Service Center of China Medical University Hospital, Taichung City, Taiwan, Republic of China
8  Department of Plastic Surgery, China Medical University, Taichung City, Taiwan, Republic of China
,
Kuo-Chung Yang
1  Division of Plastic and Reconstructive Surgery, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan, Republic of China
3  School of Medicine, National Yang-Ming University, Taipei, Taiwan, Republic of China
4  School of Medicine, National Defense Medical Center, Taipei, Taiwan, Republic of China
› Author Affiliations
Funding None.

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.



Publication History

Received: 21 August 2020

Accepted: 19 November 2020

Publication Date:
31 January 2021 (online)

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