Osteoradionecrosis (ORN) is a severe and devastating late complication of radiotherapy in patients with head and neck cancer. Management of ORN remains controversial and the current approach has been focused on debridement, systemic antibiotics, and eventually hyperbaric oxygen therapy for small and limited ORN. However, this conservative approach is ineffective in controlling extensive bone and soft-tissue necrosis. Microvascular composite flaps have been used in a variety of head and neck ablative surgeries but its use for the management of ORN has not been fully explored. From 1999 to 2002, 5 patients with refractory ORN of the mandible underwent radical resection and reconstruction with immediate microvascular-free fibular composite flap. All patients had been treated initially with conservative procedures and hyperbaric oxygen therapy. All patients had initially successful vascularized reconstruction by clinical examination with minimal postoperative morbidity. One patient had complete flap loss at 20 days due to orocutaneous fistula and infection. Radical resection followed by microvascular composite flap reconstruction is a reliable procedure in the management of patients with extensive ORN of the mandible.

Curi, Oliveira dos Santos, Feher, Faria, Rodrigues, Kowalski, , , (2007). Management of extensive osteoradionecrosis of the mandible with radical resection and immediate microvascular reconstruction. Journal of oral and maxillofacial surgery : official journal of the American Association of Oral and Maxillofacial Surgeons, 2007 Mar;65(3):434-8. https://www.ncbi.nlm.nih.gov/pubmed/17307589