A systematic review of microsurgical reconstruction of the jaws using vascularized fibula flap technique in patients with bisphosphonate-related osteonecrosis

Abstract

ObjectiveThe aim of this systematic review was to assess the role of microsurgical reconstruction of the jaws in patients with bisphosphonate-related osteonecrosis, and biological complications after an observation period of at least 12 months. Material and methodsAn electronic MEDLINE search supplemented by manual searching was conducted to identify studies reporting data of at least 12 months observation on the microsurgical reconstruction of the jaws in patients with bisphosphonate-related osteonecrosis. ResultsFour studies resulted eligible for the analysis yielded. Three out of five studies were free of complications, with a success rate of 100% as no recurrence of osteonecrosis was registered. ConclusionsMicrosurgical reconstruction of the jaws represents a valid treatment modality in patients with bisphosphonate-related osteonecrosis at 3rd stage of the disease.

Fibula Free Flap for Mandibular Reconstruction using Simulation Surgery in Bisphosphonate related Osteonecrosis of the Jaw

“…Even in stage III patient, to reconstruct with free flap has rise a controversy because of possible delayed healing in the donor site (8,9,18,19). Bone flaps such as iliac crest free flap, fibular free flap and scapular flap expose normal bone tissue which has a possibility to cause BRONJ in other bones.…”

“…Free fibular flap is the most useful flap for maxilla-mandibular hard and soft tissue reconstruction (7)(8)(9)(10)(11). The advantages of fibular free flap are simultaneous soft and hard tissue reconstruction and placing implant in reconstructed mandible and maxilla.…”

Microsurgical Reconstruction After Bisphosphonate-Related Osteonecrosis of the Jaw

“…The primary aim of BRONJ management is the prevention of infection of the necrotic bone and the reduction of symptoms. 13 Several authors have advocated against microvascular mandible reconstruction after BRONJ because of (1) high surgical risk cancer population and limited life expectancy; (2) altered wound healing and bone remodeling, leading to delayed or impaired osseointegration of bone grafts; (3) risk of transferring bone that has been exposed to similar BP therapy; (4) risk of failure to obtain a BRONJ-free margin of bone resection that is cited as one of the causes of the nonunion; (5) likelihood of presence or development of necrotic bone at the recipient site; (6) the placement of titanium plate often providing symptom resolution with adequate function; and (7) risk of transferring malignancy to the jaw. 2,10 Conservative approach, including medical treatments (antimicrobial mouth rinses, systemic antibiotics analgesics) and local surgical debridement, has been largely proposed and accepted for patient at stages 0 to 2.…”

Surgical treatment of bisphosphonate-associated osteonecrosis: Prognostic score and long-term results

“…Therefore a vascularized bone reconstruction is an important matter to be discussed. A case series of vascularized fibula flap reconstruction resulted in a higher success rate of 86e100%, while being not critical (Nocini et al, 2009;Seth et al, 2010;Pautke et al, 2011b;Sacco et al, 2011;Hanasono et al, 2013). As bone metastases could be transferred, rehabilitation by an implant supported denture is questionable (Gr€ otz et al, 2010).…”