Microvascular reconstruction of midface osteoradionecrosis

IF 4.6 Q2 MATERIALS SCIENCE, BIOMATERIALS ACS Applied Bio Materials Pub Date : 2024-06-07 DOI:10.1002/hed.27824

Larissa Sweeny MD, Neeraja Konuthula MD, Ryan Jackson MD, Mark K. Wax MD, Joseph M. Curry MD, Sara Yang MD, Dev Amin MD, Anne C. Kane MD, Steve B. Cannady MD, Kendall Tasche MD, Michael DiLeo MD, Daniel Lander MD, Alexandra E. Kejner MD, Patrik Pipkorn MD

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Abstract

Background

Head and neck osteoradionecrosis (ORN) of the midface requiring free flap (FF) reconstruction is uncommon. This multi-institutional study was designed to review outcomes for this rare patient population.

Methods

Retrospective multi-institutional review of FF reconstruction for midface ORN (2005–2022; n = 54).

Results

The FF survival rate was 87% (n = 54). Patients were less likely to be tolerating a regular diet at 3 months postoperative if they had a preoperative history of prior head and surgery (80% vs. 95%; p = 0.02), a pathologic fracture (50% vs. 90%; p = 0.04), exposed bone intraorally (43% vs. 94%; p = 0.002), or a fistula (67% vs. 96%; p = 0.03). Mean albumin was higher in patients whose FF survived (3.6 ± 0.5 vs. 2.7 ± 1.4; p = 0.03). Patients with low prealbumin were more likely to undergo a hematoma evacuation (27% vs. 0%; p = 0.02).

Conclusion

In this series of midface ORN requiring FF reconstruction preoperative nutritional status impacted postoperative complications. Preoperative occurrence of a fistula, pathologic fracture, and intraoral bone exposure correlated with decreased tolerance of a regular diet following reconstruction.

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面中部骨坏死的微血管重建术

背景：需要进行游离皮瓣（FF）重建的头颈部中面骨坏死（ORN）并不常见。这项多机构研究旨在回顾这一罕见患者群体的治疗效果：方法：多机构回顾性分析游离皮瓣重建治疗中面部ORN的情况（2005-2022年；n = 54）：结果：FF存活率为87%（n = 54）。如果患者术前有头部手术史（80% 对 95%；P = 0.02）、病理性骨折（50% 对 90%；P = 0.04）、室内骨质暴露（43% 对 94%；P = 0.002）或瘘管（67% 对 96%；P = 0.03），则术后 3 个月能接受常规饮食的可能性较低。FF存活患者的平均白蛋白较高（3.6 ± 0.5 vs. 2.7 ± 1.4；p = 0.03）。前白蛋白低的患者更有可能接受血肿清除术（27% vs. 0%; p = 0.02）：结论：在这一系列需要进行 FF 重建的中面部 ORN 患者中，术前营养状况对术后并发症有影响。术前出现瘘管、病理性骨折和口内骨暴露与重建后对常规饮食的耐受性降低有关。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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