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Case Series: Free Tissue Reconstruction of Complex Osteoradionecrosis Wounds in the Lumbar Spine, Lateral Orbit, Mandible, and Scalp
Rafael A. Couto MD, Paul Durand MD, Mona Ascha BS, Brian Gastman MD
Cleveland Clinic Foundation
2015-03-15
Presenter: Rafael A. Couto, MD
Affidavit:
I certify that this abstract has not been previosly presented at a major meeting.All work related to this abstract have been completed by the authorship enlisted below.
Director Name: Steven Bernard, MD
Author Category: Resident Plastic Surgery
Presentation Category: Clinical
Abstract Category: General Reconstruction
Introduction
Osteoradionecrosis (ORN) is a process of bone devascularization, fibrous replacement, and subsequent impaired wound healing caused by radiation therapy. Radical resection followed by free tissue coverage has been the method of choice in the surgical management of ORN. The literature describing the use of free tissue transfer for the treatment of ORN is mostly based from case reports/series focusing in mandibular reconstruction. Consequently, it has become unclear whether this technique can be extrapolated to treat ORN defects in other parts of the body.
Methods
We report four patients who underwent successful reconstruction of complex ORN wounds in different anatomical locations with free tissue transfer. The case series include subjects with severe ORN of the lumbar region, lateral orbit, and scalp that underwent free tissue reconstruction with latissimus dorsi, osteocutaneous radial forearm, and omental flaps, respectively. Furthermore, we present a case where bilateral mandibular ORN is reconstructed with a single osteocutaneous free fibula flap. In this series, two individuals required creation of recipient vascularity with arteriovenous loop.
Conclusions
Free tissue transfer provides an effective and versatile reconstructive management for extensive ORN throughout the body. Furthermore, the arteriovenous loop serves as an important tool when performing free tissue coverage to a radiated wound bed.
