Anterolateral Thigh Fascia Lata Rescue Flap: A New Weapon in the Battle Against Osteoradionecrosis.

Abstract

OBJECTIVES\nTo demonstrate that the anterolateral thigh fascia lata (ALTFL) rescue flap may be effectively used for management of osteoradionecrosis (ORN) in selected patients.\n\n\nSTUDY DESIGN\nRetrospective case review.\n\n\nMETHODS\nRetrospective chart review was performed on patients who underwent ALTFL free flap repair to various sites of ORN in the head and neck between 2011 and 2018. Inclusion criteria were patients with radiographic and clinical evidence of head and neck ORN who either failed previous hyperbaric oxygen (HBO) therapy or with extensive disease, which was unlikely to respond to conservative management.\n\n\nRESULTS\nTwenty-three patients with average age of 63\u2009years (40-78) who underwent 24 ALTFL free flap procedures were reviewed. ORN sites were the mandible (n\xa0=\xa016), palatomaxilla (n\xa0=\xa04), skull base and cervical spine (n\xa0=\xa03), and calvarium (n\xa0=\xa02). Recipient vessels used were superficial temporal (n\xa0=\xa011), common facial (n\xa0=\xa010), and angular (n\xa0=\xa03). Average hospital stay was 3.0 (1-10) days. Prior HBO therapy was performed in 13 (57%) patients. There were four major complications: flap failure, recurrent mandibular infection resolved with IV antibiotic course, mandibular fracture with malunion requiring occlusal adjustment, and unresolved sequelae of ORN requiring fibular free flap. There were four minor complications: thigh hematoma, thigh seroma, and intraoral scar formation causing trismus (n\xa0=\xa02). The procedure was successful in 22 of 23 (95.7%) patients with radiographic arrest of ORN, resolution of symptoms, and elimination of antibiotic requirements.\n\n\nCONCLUSION\nThe ALTFL rescue flap merits strong consideration in ORN management and appears to prevent progression to more extensive disease, which would require full segmental bone resection and reconstruction.\n\n\nLEVEL OF EVIDENCE\n4 Laryngoscope, 2021.