{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,17]],"date-time":"2026-08-17T14:42:32Z","timestamp":1786977752510,"version":"build-2736575974"},"reference-count":35,"publisher":"Wiley","issue":"11","license":[{"start":{"date-parts":[[2024,6,7]],"date-time":"2024-06-07T00:00:00Z","timestamp":1717718400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Head &amp; Neck"],"published-print":{"date-parts":[[2024,11]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Osteoradionecrosis (ORN) of the mandible is an unfortunate potential sequela of radiotherapy for head and neck cancer. In advanced cases of ORN, mandibulectomy, and free fibula flap reconstruction are required. We hypothesized that patients undergoing fibula free flap reconstruction and mandibulectomy for ORN pose unique challenges and experience more complications than patients undergoing fibula free flaps after oncologic mandibulectomy.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>After IRB approval, we created a database of all free fibula flaps for mandible reconstruction from April 2005 through February 2019. Medical records were retrospectively reviewed for patient and surgical characteristics and postoperative outcomes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Four\u2010hundred seventy\u2010nine patients met the inclusion criteria (168 ORN vs. 311 non\u2010ORN patients). Propensity\u2010matching was performed based on age, BMI, smoking status, preoperative chemotherapy, and virtual surgery planning use, which yielded 159 patients in each group. ORN patients received more double\u2010skin\u2010island fibula flaps than non\u2010OR patients (20.8% vs. 5.7%,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001). Recipient artery other than the facial artery was utilized more commonly in ORN patients (42.1% vs. 17.0%,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001). In the unmatched cohort, ORN patients had higher rates of delayed wound healing (26.2% vs. 16.8%,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.01) and surgical site infections (21.4% vs. 13.2%,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.02). Rates of flap loss, return to the operating room, hematoma, operative time, and length of stay were similar between the groups. On logistic regression analysis, osteoradionecrosis was an independent risk factor for delayed wound healing.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Based on these data, mandibular reconstruction with fibula flaps for osteoradionecrosis appears more complicated than mandible reconstruction following de novo cancer resection. Surgeons should anticipate employing two skin islands for intraoral and extraoral resurfacing, utilizing unconventional recipient vessels, and managing the delayed wound healing that ensues more commonly than non\u2010ORN patients.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/hed.27823","type":"journal-article","created":{"date-parts":[[2024,6,7]],"date-time":"2024-06-07T07:16:53Z","timestamp":1717744613000},"page":"2834-2842","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":9,"title":["Free fibula mandible reconstruction for osteoradionecrosis is more challenging than for primary cancer"],"prefix":"10.1002","volume":"46","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5096-1959","authenticated-orcid":false,"given":"Z\u2010Hye","family":"Lee","sequence":"first","affiliation":[{"name":"Department of Plastic and Reconstructive Surgery The University of Texas M. D. Anderson Cancer Center  Houston Texas USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John W.","family":"Shuck","sequence":"additional","affiliation":[{"name":"Department of Plastic and Reconstructive Surgery The University of Texas M. D. Anderson Cancer Center  Houston Texas USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rene D.","family":"Largo","sequence":"additional","affiliation":[{"name":"Department of Plastic and Reconstructive Surgery The University of Texas M. D. Anderson Cancer Center  Houston Texas USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Edward I.","family":"Chang","sequence":"additional","affiliation":[{"name":"Department of Plastic and Reconstructive Surgery The University of Texas M. D. Anderson Cancer Center  Houston Texas USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matthew M.","family":"Hanasono","sequence":"additional","affiliation":[{"name":"Department of Plastic and Reconstructive Surgery The University of Texas M. D. Anderson Cancer Center  Houston Texas USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peirong","family":"Yu","sequence":"additional","affiliation":[{"name":"Department of Plastic and Reconstructive Surgery The University of Texas M. D. Anderson Cancer Center  Houston Texas USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Patrick B.","family":"Garvey","sequence":"additional","affiliation":[{"name":"Department of Plastic and Reconstructive Surgery The University of Texas M. D. Anderson Cancer Center  Houston Texas USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2024,6,7]]},"reference":[{"key":"e_1_2_8_2_1","doi-asserted-by":"publisher","DOI":"10.1002\/cncr.30803"},{"key":"e_1_2_8_3_1","doi-asserted-by":"publisher","DOI":"10.1155\/2023\/1440889"},{"key":"e_1_2_8_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.oraloncology.2017.07.014"},{"key":"e_1_2_8_5_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijrobp.2012.05.032"},{"key":"e_1_2_8_6_1","doi-asserted-by":"publisher","DOI":"10.1002\/hed.23949"},{"key":"e_1_2_8_7_1","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.2004.09.959"},{"key":"e_1_2_8_8_1","doi-asserted-by":"publisher","DOI":"10.1055\/s-0040-1721759"},{"key":"e_1_2_8_9_1","doi-asserted-by":"publisher","DOI":"10.1097\/MOO.0000000000000571"},{"key":"e_1_2_8_10_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.amjoto.2022.103586"},{"key":"e_1_2_8_11_1","doi-asserted-by":"publisher","DOI":"10.1097\/PRS.0000000000007161"},{"key":"e_1_2_8_12_1","doi-asserted-by":"publisher","DOI":"10.1002\/lary.29379"},{"key":"e_1_2_8_13_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.oraloncology.2010.08.007"},{"key":"e_1_2_8_14_1","doi-asserted-by":"publisher","DOI":"10.1097\/PRS.0000000000007546"},{"key":"e_1_2_8_15_1","doi-asserted-by":"publisher","DOI":"10.1055\/s-0040-1717101"},{"key":"e_1_2_8_16_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jcms.2019.01.037"},{"key":"e_1_2_8_17_1","doi-asserted-by":"publisher","DOI":"10.1097\/PRS.0000000000008085"},{"key":"e_1_2_8_18_1","doi-asserted-by":"publisher","DOI":"10.1002\/hed.26688"},{"key":"e_1_2_8_19_1","unstructured":"ACS National Surgical Quality Improvement Program; ACS.https:\/\/www.facs.org\/quality-programs\/data-and-registries\/acs-nsqip\/"},{"key":"e_1_2_8_20_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.bjoms.2020.11.013"},{"key":"e_1_2_8_21_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.otohns.2009.03.013"},{"key":"e_1_2_8_22_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.joms.2007.08.041"},{"key":"e_1_2_8_23_1","doi-asserted-by":"publisher","DOI":"10.1002\/jso.24976"},{"key":"e_1_2_8_24_1","doi-asserted-by":"publisher","DOI":"10.1111\/odi.13762"},{"key":"e_1_2_8_25_1","doi-asserted-by":"publisher","DOI":"10.1002\/hed.27024"},{"key":"e_1_2_8_26_1","doi-asserted-by":"publisher","DOI":"10.1186\/s13014-020-01701-5"},{"key":"e_1_2_8_27_1","doi-asserted-by":"publisher","DOI":"10.1002\/hed.24907"},{"key":"e_1_2_8_28_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jcms.2015.03.006"},{"key":"e_1_2_8_29_1","doi-asserted-by":"publisher","DOI":"10.1097\/01.PRS.0000145637.61941.94"},{"key":"e_1_2_8_30_1","doi-asserted-by":"publisher","DOI":"10.1002\/micr.30322"},{"key":"e_1_2_8_31_1","doi-asserted-by":"publisher","DOI":"10.1002\/jso.24647"},{"key":"e_1_2_8_32_1","doi-asserted-by":"publisher","DOI":"10.1097\/PRS.0000000000003523"},{"key":"e_1_2_8_33_1","doi-asserted-by":"publisher","DOI":"10.1097\/PRS.0b013e318262f115"},{"key":"e_1_2_8_34_1","doi-asserted-by":"publisher","DOI":"10.1097\/PRS.0000000000004770"},{"key":"e_1_2_8_35_1","doi-asserted-by":"publisher","DOI":"10.1097\/PRS.0000000000003854"},{"key":"e_1_2_8_36_1","doi-asserted-by":"publisher","DOI":"10.1097\/PRS.0000000000001106"}],"container-title":["Head &amp; Neck"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/hed.27823","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,10,14]],"date-time":"2024-10-14T07:23:21Z","timestamp":1728890601000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1002\/hed.27823"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,6,7]]},"references-count":35,"journal-issue":{"issue":"11","published-print":{"date-parts":[[2024,11]]}},"alternative-id":["10.1002\/hed.27823"],"URL":"https:\/\/doi.org\/10.1002\/hed.27823","archive":["Portico"],"relation":{},"ISSN":["1043-3074","1097-0347"],"issn-type":[{"value":"1043-3074","type":"print"},{"value":"1097-0347","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,6,7]]},"assertion":[{"value":"2023-12-12","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2024-05-15","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2024-06-07","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}