Treatment of Mandibular Osteoradionecrosis Using A Fibular Flap： A Study on Transplant Site Infection in a Fibular Flap Reconstruction Cases

Abstract

　　We perform reconstruction using a fibular flap after mandibulectomy for surgical treatment of mandibular osteoradionecrosis in our department. However, pre-existing infection in the surgical field predisposes patients to postoperative infection. In this study, we investigated the incidence of surgical site infection （SSI） in the neck in patients with mandibular osteoradionecrosis who underwent reconstruction using a fibular flap. This retrospective study included 11 patients with mandibular osteoradionecrosis who underwent mandibulectomy and fibular flap reconstruction between January 2013 and December 2022 at our hospital. SSI occurred in eight patients (73%), Among the three patients without SSI, two underwent simultaneous transplantation of an anterolateral thigh flap and a pectoralis major flap, respectively. One patient developed a recurrent infection, followed by contralateral mandibular osteomyelitis, necessitating re-mandibulectomy and reconstruction using another fibular flap. Despite the high incidence of SSI （73%), infection control was achieved through irrigation and negative-pressure wound therapy. Patients with osteoradionecrosis have pre-existing infection around the mandible and low skin extensibility secondary to radiation therapy, which may lead to dead space formation and consequent SSI. Simultaneous transplantation of additional flaps along with a fibula flap may be beneficial to completely fill the dead space and minimize the risk of SSI in such cases.