Microvascular Reconstruction of Osteonecrosis: Assessment of Long‐term Quality of Life

Abstract

Objective Review long-term clinical and quality-of-life outcomes following free flap reconstruction for osteonecrosis. Study Design Retrospective multi-institutional review. Setting Tertiary care centers. Methods Patients included those undergoing free flap reconstructions for osteonecrosis of the head and neck (N = 232). Data included demographics, defect, donor site, radiation history, perioperative management, diet status, recurrence rates, and long-term quality-of-life outcomes. Quality-of-life outcomes were measured using the University of Washington Quality of Life (UW-QOL) survey. Results Overall flap success rate was 91% (n = 212). Relative to preoperative diet, 15% reported improved diet function at 3 months following reconstruction and 26% at 5 years. Osteonecrosis recurred in 14% of patients (32/232); median time to onset was 11 months. Cancer recurrence occurred in 13% of patients (29/232); median time to onset was 34 months. Results from the UW-QOL questionnaire were as follows: no pain (45%), minor or no change in appearance (69%), return to baseline endurance level (37%), no limitations in recreation (40%), no changes in swallowing following reconstruction (28%), minor or no limitations in mastication (29%), minor or no speech difficulties (93%), no changes in shoulder function (84%), normal taste function (19%), normal saliva production (27%), generally excellent mood (44%), and no or minimal anxiety about cancer (94%). Conclusion The majority of patients maintained or had advancement in diet following reconstruction, with low rates of osteonecrosis or cancer recurrence and above-average scores on UW-QOL survey suggesting good return of function and quality of life.

Outcomes after definitive surgery for mandibular osteoradionecrosis

“…There was a significant difference in preoperative versus postoperative swallowing function, with an absolute improvement of 11% in patients eating a regular diet, but no difference in gastrostomy tube dependency. This is consistent with Sweeny et al, who reported 15% and 26% of patients reported improved diet function at 3 months and 5 years, respectively 33 . Despite no significant improvement in gastrostomy tube dependency, the postoperative gastrostomy tube dependency rate was 23%, which compares favorably to the reported 34% gastrostomy tube dependency rate for major oral cavity cancer ablative and reconstructive surgery 34 …”

“…While IMRT may reduce the risk of ORN, once ORN develops, it is unclear if patients who had been treated with IMRT have differing outcomes 3,9 . This study does not assess biochemical measures of morbidity, such as malnutrition or hypothyroidism, which would aid in the quantification patients' underling poor health 33 . Postoperative functional measures were the final assessment performed for each patient.…”

“…3,9 This study does not assess biochemical measures of morbidity, such as malnutrition or hypothyroidism, which would aid in the quantification patients' underling poor health. 33 Postoperative functional measures were the final assessment performed for each patient. Although this gives the best representation of ultimate outcome, variability in the time that patients were measured limits the reproducibility and predictability of these functional measures.…”

Impact of preoperative and intraoperative management on outcomes in osteoradionecrosis requiring free flap reconstruction

“…As a result, patients with advanced osteoradionecrosis often present with severe pain, draining fistulas, or pathologic fractures. These sequelae reduce the patient's quality of life secondary to chronic pain, inability to tolerate oral intake, and social anxiety 1,2 …”

A review of advanced head and neck osteoradionecrosis

“…A retrospective study found that patients who received pentoxifylline and tocopherol after radiation had a lower incidence of ORN [20] . Dissard et al [21] also found that administration of the PENTOCLO regimen daily had a low side effect profile with high rates of symptom improvement when given antibiotics and steroids.…”