Osteomyocutaneous Free Fibula Flap Prevents Osteoradionecrosis and Osteomyelitis in Head and Neck Cancer Reconstruction
Research article published in Journal of reconstructive microsurgery (2021)
Abstract
BACKGROUND: Osteoradionecrosis (ORN) is one of the most severe complications of free fibula reconstruction after radiotherapy. The gold standard treatment of osteomyelitis involves extensive debridement, antibiotics, and sufficiently vascularized muscle flap coverage for better circulation. Therefore, we hypothesized that free fibula flap with muscle could decrease the risk of ORN. METHODS: This study consisted of 85 patients who underwent reconstruction with free fibula flap in head and neck cancer by a single reconstructive surgeon at Kaohsiung Veterans General Hospital over a period of 19 years (1998-2016). Patients with postoperative adjuvant radiotherapy were included in the study and were grouped by either free fibula osteocutaneous flap or free fibula osteomyocutaneous flap (with flexor hallucis longus muscle), and the incidence of ORN was compared. RESULTS: Of the 85 patients, 15 were reconstructed with osteocutaneous fibula flap and 70 were with osteomyocutaneous fibula flap. The rate of ORN or osteomyelitis was significantly lower in the muscle group (18.6%, n = 13/70 vs. 46.7%, n = 7/15, p = 0.020, Chi-square test). CONCLUSION: Vascularized muscle transfer increases perfusion of surrounding tissues and the bone flap, thereby decreasing the incidence of osteomyelitis or osteonecrosis.
Abstract sourced from PubMed (NCBI) for the cited record. See the original publication for the authoritative version.
Summary
Peer-reviewed research on infection control, antibiotic prophylaxis, and safety relevant to leech therapy and microsurgical reconstruction. Indexed in PubMed and verified against the NCBI record.
Why This Matters for Hirudotherapy
In this 19-year single-surgeon series of 85 head-and-neck cancer patients reconstructed with free fibula flaps and given postoperative radiotherapy, adding flexor hallucis longus muscle (osteomyocutaneous flap) was associated with a significantly lower rate of osteoradionecrosis or osteomyelitis (18.6% vs 46.7%, p = 0.020), attributed to better tissue perfusion. For ASH the link is indirect: it reinforces that flap perfusion drives reconstructive outcomes, which is the same physiological rationale behind using leeches to decompress venous-congested flaps, though the study addresses bone complications, not leech salvage. Caveat: this is a retrospective, single-surgeon, single-institution cohort with markedly unequal group sizes (70 vs 15) and no involvement of leech therapy, so it informs surgical context only and should not be read as evidence about hirudotherapy.
Citation
Osteomyocutaneous Free Fibula Flap Prevents Osteoradionecrosis and Osteomyelitis in Head and Neck Cancer Reconstruction.
Wang et al. · Journal of reconstructive microsurgery, 2021
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