Dziegielewski Peter T, Bernard Stewart, Mendenhall William M, Hitchock Kathryn E, Parker Gibbs Charles, Wang Joy, Amdur Robert J, Silver Natalie L, Hardeman John, Seikaly Hadi, Reschly William J, Danan Deepa, Sawhney Raja
Department of Otolaryngology, University of Florida, Gainesville, Florida.
University of Florida Health Cancer Center, Gainesville, Florida.
Head Neck. 2020 Aug;42(8):1928-1938. doi: 10.1002/hed.26118. Epub 2020 Mar 5.
To determine the rate and risk factors for osteoradionecrosis (ORN) in osseous free flaps after postoperative radiation therapy (PORT). To describe the treatment of free flap ORN.
Seventy-four patients undergoing osseous free flap reconstruction were analyzed. Thirty-eight completed PORT. Patients were followed for ≥6 months.
The rate of ORN was 34% overall; 0% with 50 to 59.9 Gy; 8% with 60 Gy; 40% with 66 Gy; 56% with 70 to 74.4 Gy. Mean time to ORN was 13.1 months. 0/28 patients without PORT developed free flap osteonecrosis. Multivariate analysis found the only factor predicting ORN: PORT >60 Gy, which increased the risk 21-fold. Treatment included PENTACLO, hyperbaric oxygen, and surgical debridement with 75% within 2 years.
PORT >60 Gy is significantly associated with free flap ORN. As the dose of adjuvant RT increases beyond 60 Gy, the risk of ORN in free flaps rises. Consideration should be given to lower PORT doses or delaying free flap reconstruction when feasible.
确定术后放射治疗（PORT）后骨游离皮瓣骨放射性坏死（ORN）的发生率及危险因素。描述游离皮瓣ORN的治疗方法。
分析74例行骨游离皮瓣重建的患者。38例完成PORT。对患者进行≥6个月的随访。
ORN总发生率为34%；50至59.9 Gy时为0%；60 Gy时为8%；66 Gy时为40%；70至74.4 Gy时为56%。ORN的平均发生时间为13.1个月。28例未接受PORT的患者均未发生游离皮瓣骨坏死。多因素分析发现预测ORN的唯一因素：PORT>60 Gy，其风险增加21倍。治疗方法包括五氯酚、高压氧和手术清创，2年内75%的患者采用这些方法。
PORT>60 Gy与游离皮瓣ORN显著相关。随着辅助放疗剂量增加超过60 Gy，游离皮瓣ORN的风险升高。可行时应考虑降低PORT剂量或延迟游离皮瓣重建。
