Influence of radiation on late complications in patients with free fibularflaps for mandibular reconstruction

Carcinoma of the mandible is a disease that evokes images of devastating fu nctional and cosmetic outcomes. Most of these malignancies require treatmen t with surgical resection and perioperative irradiation (XRT). To minimize the incidence of postoperative complications, the timing of perioperative X RT has been questioned. This study reviewed 140 patients at M.D. Anderson C ancer Center over a 7-year period who underwent mandibular resection and re construction with a free fibular flap. The patients were divided into the f ollowing four groups: (1) preoperative XRT followed by immediate reconstruc tion, (2) preoperative XRT followed by delayed reconstruction, (3) postoper ative XRT, and (4) no XRT. The complications studied included exposure of b ane and hardware, orocutaneous fistula, osteoradionecrosis, partial and com plete flap loss, and severe cervical contractures. Of the 140 patients stud ied, 59 (42%) had at least one complication. Complications per group were t he following: group 1, 45%; group 2, 46%; group 3, 47%; and group 4, 28%. T he results show that the incidence of complications is relatively equal bet ween groups that received preoperative vs. postoperative XRT.