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Osteoradionecrosis in osseous free flap reconstruction: Risk factors and treatment.
Dziegielewski, Peter T; Bernard, Stewart; Mendenhall, William M; Hitchock, Kathryn E; Parker Gibbs, Charles; Wang, Joy; Amdur, Robert J; Silver, Natalie L; Hardeman, John; Seikaly, Hadi; Reschly, William J; Danan, Deepa; Sawhney, Raja.
  • Dziegielewski PT; Department of Otolaryngology, University of Florida, Gainesville, Florida.
  • Bernard S; University of Florida Health Cancer Center, Gainesville, Florida.
  • Mendenhall WM; Division of Otolaryngology-Head and Neck Surgery, University of Alberta, Edmonton, Alberta, Canada.
  • Hitchock KE; Department of Otolaryngology, University of Florida, Gainesville, Florida.
  • Parker Gibbs C; Division of Otolaryngology-Head and Neck Surgery, University of Alberta, Edmonton, Alberta, Canada.
  • Wang J; University of Florida Health Cancer Center, Gainesville, Florida.
  • Amdur RJ; Department of Radiation Oncology, University of Florida, Gainesville, Florida.
  • Silver NL; Division of Otolaryngology-Head and Neck Surgery, University of Alberta, Edmonton, Alberta, Canada.
  • Hardeman J; University of Florida Health Cancer Center, Gainesville, Florida.
  • Seikaly H; Department of Radiation Oncology, University of Florida, Gainesville, Florida.
  • Reschly WJ; Division of Otolaryngology-Head and Neck Surgery, University of Alberta, Edmonton, Alberta, Canada.
  • Danan D; Department of Orthopedic Surgery, University of Florida, Gainesville, Florida.
  • Sawhney R; Division of Otolaryngology-Head and Neck Surgery, University of Alberta, Edmonton, Alberta, Canada.
Head Neck ; 42(8): 1928-1938, 2020 08.
Article en En | MEDLINE | ID: mdl-32134160
OBJECTIVE: To determine the rate and risk factors for osteoradionecrosis (ORN) in osseous free flaps after postoperative radiation therapy (PORT). To describe the treatment of free flap ORN. METHODS: Seventy-four patients undergoing osseous free flap reconstruction were analyzed. Thirty-eight completed PORT. Patients were followed for ≥6 months. RESULTS: The rate of ORN was 34% overall; 0% with 50 to 59.9 Gy; 8% with 60 Gy; 40% with 66 Gy; 56% with 70 to 74.4 Gy. Mean time to ORN was 13.1 months. 0/28 patients without PORT developed free flap osteonecrosis. Multivariate analysis found the only factor predicting ORN: PORT >60 Gy, which increased the risk 21-fold. Treatment included PENTACLO, hyperbaric oxygen, and surgical debridement with 75% within 2 years. CONCLUSION: PORT >60 Gy is significantly associated with free flap ORN. As the dose of adjuvant RT increases beyond 60 Gy, the risk of ORN in free flaps rises. Consideration should be given to lower PORT doses or delaying free flap reconstruction when feasible.
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Texto completo: 1 Banco de datos: MEDLINE Asunto principal: Osteorradionecrosis / Enfermedades Mandibulares / Procedimientos de Cirugía Plástica / Colgajos Tisulares Libres Tipo de estudio: Etiology_studies / Observational_studies / Prognostic_studies / Risk_factors_studies Límite: Humans Idioma: En Año: 2020 Tipo del documento: Article
Texto completo
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Texto completo: 1 Banco de datos: MEDLINE Asunto principal: Osteorradionecrosis / Enfermedades Mandibulares / Procedimientos de Cirugía Plástica / Colgajos Tisulares Libres Tipo de estudio: Etiology_studies / Observational_studies / Prognostic_studies / Risk_factors_studies Límite: Humans Idioma: En Año: 2020 Tipo del documento: Article