Maxillofacial Re‐Reconstruction of Bony Free Flaps Affected by Osteoradionecrosis: 10‐Year Single‐Institution Experience

BACKGROUND: Little is known about outcomes after re-reconstruction of free flaps affected by ORN. METHODS: A retrospective cohort study was conducted. Eligible patients previously underwent osteocutaneous free flap reconstruction, received adjuvant RT, later developed ORN of the flap, and underwent repeat free flap reconstruction. Primary outcome measured was flap survival. Secondary outcomes measured included intraoperative blood loss, operative time, length of stay, complications, and functional recovery after the second reconstruction. RESULTS: Eight patients met inclusion criteria and all secondary flaps survived (100%). Secondary reconstructions showed significantly reduced mean intraoperative blood loss (300 vs. 689 mL, p = 0.042), shorter operative time (736 vs. 810 min), and hospital stay (8.6 vs. 12.9 days). By 6 months, all postoperative patients were decannulated and independent of gastrostomy tubes. CONCLUSION: Secondary osseous free flap reconstruction after ORN represents a reliable salvage option for patients with medically refractory ORN.