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

Erica Mayland, Joseph M. Curry, Mark K. Wax, Carissa M. Thomas, Brian P. Swendseid, Alexandra E. Kejner, Joshua J. Kain, Steven B. Cannady, Brett A. Miles, Michael DiLeo, Caitlin McMullen, Kendall Tasche, Rocco M. Ferrandino, Juliana Sarwary, Daniel Petrisor, Larissa Sweeny

Research output: Contribution to journalArticlepeer-review

5 Scopus citations


Background: Perioperative management of advanced osteoradionecrosis of the head and neck requiring free flap (FF) reconstruction varies. Our objectives included assessment of practice patterns and outcomes. Methods: Multi-institutional, retrospective review of FF reconstruction for head and neck osteoradionecrosis (n = 260). Results: Administration of preoperative antibiotics did not correlate with reduction in postoperative complications. Preoperative alcohol use correlated with higher rates of hardware exposure (p = 0.03) and 30-day readmission (p = 0.04). Patients with FF compromise had higher TSH (p = 0.04) and lower albumin levels (p = 0.005). Prealbumin levels were lower in patients who required neck washouts (p = 0.02) or a second FF (p = 0.03). TSH levels were higher in patients undergoing postoperative debridement (p = 0.03) or local flap procedures (p = 0.04). Conclusion: Malnutrition, hypothyroidism, and substance abuse correlated with a higher incidence of postoperative wound complications in patients undergoing FF reconstruction for advanced osteoradionecrosis. Preoperative antibiotics use did not correlate with a reduction in postoperative wound complications.

Original languageEnglish (US)
Pages (from-to)698-709
Number of pages12
JournalHead and Neck
Issue number3
StatePublished - Mar 2022


  • free flap
  • head and neck
  • microvascular
  • osteoradionecrosis
  • reconstruction

ASJC Scopus subject areas

  • Otorhinolaryngology


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