Osteomyocutaneous Free Fibula Flap Prevents Osteoradionecrosis and Osteomyelitis in Head and Neck Cancer Reconstruction

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.

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.

Explore cómo esta investigación se conecta con la práctica clínica

More peer-reviewed studies in Seguridad y control de infecciones.

• Leech-Assisted Flap Salvage — Systematic Review of 277 Cases — Whitaker et al. (2012)
• Effects of hirudotherapy on liver functions, lipid profile, and insulin sensitivity in rats with metabolic syndrome — Bilden A et al. (2026)
• AIF-1 and RNASET2 Play Complementary Roles in the Innate Immune Response of Medicinal Leech — Baranzini N et al. (2019)
• [Hirudo medicinalis-leech applications in plastic and reconstructive microsurgery--a literature review] — Knobloch K et al. (2007)
• Bacterial symbioses of the medicinal leech Hirudo verbana — Nelson M, Graf J (2012)
• Leech related Aeromonas complex infection after reconstruction with a microvascular forearm flap — Beger B, von Loewenich F, Goetze E, Moergel M, Walter C (2016)
• Aeromonas septicemia after medicinal leech use following replantation of severed digits — Levine SM, Frangos SG, Hanna B, Colen K, Levine JP (2009)
• Outcomes of flap salvage with medicinal leech therapy — Nguyen MQ et al. (2012)
• The role of leech water sampling in choice of prophylactic antibiotics in medical leech therapy — Wilmer A et al. (2013)
• The development and application of mini-barcodes from mitochondrial DNA for identifying medicinal leeches from traditional medicines — Liu Y et al. (2025)

Browse all ASH-analysed research →