ArticleFrontiers in oncology2025
Osteoradionecrosis in osseous free flaps after maxillofacial reconstruction: a single-center experience.
Article in Frontiers in oncology, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 7 papers.
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Who cites it
7 citing papers in PubMed.
- Failure of salvage therapies in radiation-induced necrosis of a free fibula flap: a case report.Annals of medicine and surgery (2012) · 2026Article
- Postoperative radiotherapy and external carotid artery diameter: is there a link to osseous free flap osteoradionecrosis risk?Clinical oral investigations · 2026Article
- Accuracy of CAD/CAM planned mandibular reconstruction with scapula free flaps in reconstructive head and neck surgery - A single center study.Oral and maxillofacial surgery · 2026Article
- Osseous free flap vs. Bridging plate mandibular reconstruction: a retrospective cohort study on perioperative complications of 335 patients.Clinical oral investigations · 2026Article
- An ultra-late maxillofacial cavity following multimodal treatment for adult head and neck rhabdomyosarcoma: a case report with a 16-year follow-up.Frontiers in oncology · 2026Article
- Prospective functional assessment after mandible reconstruction and bone healing assessment.Clinical oral investigations · 2025Article
- Mandibular reconstruction with anterolateral thigh free flap and bridging plate: a retrospective study of 34 oncological cases.Frontiers in surgery · 2025Article
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11 authors.
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Abstract
Objective: In the multimodal treatment of advanced head and neck malignancies, primary free flap reconstruction in a one stage procedure with tumor resection is frequently combined with adjuvant radiotherapy. Radiotherapy is known to exhibit side effects on transplanted free flaps, including osteoradionecrosis (ORN) of native and transplanted bone. This study aims to evaluate the therapeutic outcomes and potential predictors of free flap ORN within osseous free flaps based on a large-scale, single-center database. Methods: A retrospective analysis was conducted on patients who underwent osseous free flap reconstruction of maxilla or mandible in a one stage procedure followed by adjuvant radiotherapy due to an advanced head and neck malignancy between April 2017 and July 2023. After case matching, patients with and without free flap ORN were assessed for potential predictors using univariate and multivariate analysis. Results: 112 patients met the inclusion criteria. 21 patients (19%) developed ORN within the free flap. Following case matching, 42 patients (10 females, mean age 61.5 ± 9.1 years) were included in the final analysis. The mean time to ORN diagnosis was 19 (7-56) months after surgery. Total flap loss occurred in 7 patients (33%) following flap ORN. Smoking (76% vs. 38%; OR 5.78; p=0.03) and prior plate exposure (67% vs. 24%; OR 5.61; p=0.03) emerged as robust predictors of flap ORN in uni- and multivariate analysis. Conclusion: Osseous free flap ORN is a severe radiooncologic complication, often resulting in total flap loss and subsequently increased morbidity. Smoking and prior plate exposure were identified as key predictors of flap ORN development. Individual risk assessment and careful evaluation of osseous free flap irradiation must be evaluated in future radiooncological concepts.
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