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Head and Neck Surgery

(354) Osteocutaneous Free Flaps in Patients with Osteoradionecrosis: Infections and Outcomes

Monday, October 2, 2023
2:45 PM – 3:45 PM East Coast USA Time
Has Audio

    Presenting Author(s)

  • Kevin M. Chacko

    Medical Student
    University of Florida College of Medicine
    Gainesville, Florida, United States

    • Co-Author(s)

  • Danny Dang

    Medical Student
    University of Florida College of Medicine
    Riverview, Florida, United States

    • Senior Author(s)

  • Peter Dziegielewski, MD

    Chief, Head and Neck Surgical Oncology & Microvascular Reconstructive Surgery
    University of Florida
    Gainesville, Florida, United States

Disclosure(s):
Kevin M. Chacko: No relevant relationships to disclose.
Danny Dang: No relevant relationships to disclose.
Peter Dziegielewski, MD: No relevant relationships to disclose.


Introduction: Recovery after free flap reconstruction in patients with osteoradionecrosis (ORN) can be challenging due to poor wound healing in irradiated tissue. The purpose of this study is to identify surgical site infection (SSI), hardware exposure, and flap failure rates in patients with ORN that underwent an osteocutaneous free flap.

Methods: A retrospective review was performed on patients that underwent an osteocutaneous free flap for osteoradionecrosis between June 2014 and June 2022 at our institution. A total of 34 patients were included in the study. SSI was defined using the CDC criteria which includes purulent drainage, organisms identified from aseptically obtained species, spontaneous wound dehiscence with fever or localized pain or tenderness, or an abscess within 30 days post-op.

Results: 82% of patients were treated preoperatively with HBO therapy and 68% with the PENTOCLO protocol. All patients had an osteocutaneous free flap (fibula, scapula, or radial forearm) and 56% received at least 6 weeks of post-operative IV antibiotics. One flap failure occurred. Within 30 days post-op, 21% of patients had an SSI in the head and neck region, 3% had an SSI at the flap donor site, 3% had pneumonia, and 3% developed C. diff infection after post-operative antibiotic prophylaxis. Six patients developed hardware exposure. In comparison to the literature, a similar study with 30 patients showed an SSI rate of 33% and six cases of hardware exposure post-operatively.

Conclusions: In patients with ORN undergoing an osteocutaneous free flap, SSI rates in the study cohort are lower than in the current literature.