Reconstruction of mandibular defects in osteoradionecrosis and medication-related osteonecrosis of the jaw using fibula free flap and management of postoperative wound infections.

IF 2 Q2 DENTISTRY, ORAL SURGERY & MEDICINE Maxillofacial Plastic and Reconstructive Surgery Pub Date : 2022-12-09 DOI:10.1186/s40902-022-00366-2
Hyemin Oh, Dohyun Kwon, Jaemyung Ahn, Jun-Young Paeng
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引用次数: 1

Abstract

Background: Complications from osteoradionecrosis (ORN) and medication-related osteonecrosis of the jaw (MRONJ) include oro-cutaneous fistulas, necrotic bone exposure, soft-tissue defects, and pathologic fractures. The fibula free flap (FFF) is a common free flap method used to reconstruct the mandible in severe cases. Recently, we have used the FFF successfully for the reconstruction of ORN and MRONJ mandibular defects. We report this method as a recommended technique for the treatment of ORN and MRONJ and the management method of postoperative infections.

Methods: Four patients who were diagnosed with ORN of the mandible and 3 patients who were diagnosed with MRONJ of the mandible were included in the study. Among the 7 patients, 3 patients also had pathologic fractures. Partial mandibulectomy and FFF reconstruction were performed at the Department of Oral and Maxillofacial Surgery, Samsung Medical Center from April 2019 to March 2021.

Results: All 7 patients recovered following the reconstruction of the defect by FFF. Four patients experienced infections after surgery and pus cultures were performed. All were well healed without flap damage after changing the antibiotics by consultation with infectious medicine experts.

Conclusion: FFF is a widely used method and can provide an extensive flap to reconstruct the mandible, especially those affected by ORN or MRONJ. If an infection occurs after surgery, appropriate antibiotic changes should be made through cooperation with the infectious medicine department. Therefore, FFF is a well-established and recommended method even in cases of challenging reconstruction.

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应用腓骨游离皮瓣重建放射性骨坏死及药物相关性颌骨骨坏死下颌骨缺损及术后伤口感染处理。
背景:放射性骨坏死(ORN)和药物相关性颌骨骨坏死(MRONJ)的并发症包括口腔-皮肤瘘、坏死骨暴露、软组织缺损和病理性骨折。腓骨游离皮瓣(fibula free flap, FFF)是修复下颌骨重建术中常用的游离皮瓣。最近,我们成功地使用FFF重建了ORN和MRONJ下颌缺损。我们报道这种方法作为治疗ORN和MRONJ的推荐技术和术后感染的管理方法。方法:选取4例诊断为下颌骨ORN的患者和3例诊断为下颌骨MRONJ的患者作为研究对象。7例患者中有3例合并病理性骨折。2019年4月至2021年3月,在三星首尔医院口腔颌面外科进行了部分下颌切除术和FFF重建手术。结果:7例患者经FFF修复后均恢复正常。4例患者术后出现感染并进行了脓培养。经咨询感染医学专家更换抗生素后,均愈合良好,皮瓣无损伤。结论:FFF是一种广泛应用的方法,可以提供广泛的皮瓣重建下颌骨,特别是对ORN或MRONJ的影响。如果术后发生感染,应与感染内科合作,适当更换抗生素。因此,即使在具有挑战性的重建情况下,FFF也是一种完善和推荐的方法。
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来源期刊
Maxillofacial Plastic and Reconstructive Surgery
Maxillofacial Plastic and Reconstructive Surgery DENTISTRY, ORAL SURGERY & MEDICINE-
CiteScore
4.30
自引率
13.00%
发文量
37
审稿时长
13 weeks
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