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Scientific Oral Presentations

Head and Neck Surgery

Session: Scientific Oral Presentations 2 - Head and Neck Surgery

Impact of Systemic Bone Density on Long-Term Outcomes in Osteocutaneous Free Flaps

Sunday, September 29, 2024
8:06 AM – 8:12 AM EDT
Location: MBCC, 208
Disclosure(s):
Ericka L. Erickson, MD:

faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.

Lingpeng Shan, MSc:

faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.

Lauren E. Miller, MD, MBA:

faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.

Matthew O. Old, MD:

faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.

Nolan B. Seim, MD, MBA:

faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.

Introduction: Osteocutaneous free flaps have transformed reconstruction in head and neck cancer, however there are uncommon, but high morbidity long-term complications such as hardware exposure, ORN, malunion, and chronic osteomyelitis. Radiation and tobacco use are known risk factors for these complications. However, the impact of baseline bone density of osteocutaneous free flaps has been incompletely examined. The purpose of this study was to characterize rates of these complications, and associated risk factors in head and neck cancer patients who undergo osteocutaneous free flaps.

Methods: A retrospective chart review of osteocutaneous free flaps from 2013-2020 was conducted at a single comprehensive cancer center. Patients undergoing surgical treatment for primary or recurrent head and neck squamous cell carcinoma were included, while osteocutaneous free flaps intended for the treatment of ORN were excluded. Patients with radiation preceding free flap were excluded. Variables studied included osteopenia, tobacco use, postoperative radiation therapy, and sex. Osteopenia was defined by radiographic evidence. The primary outcomes were nonunion at 12 months, hardware complications, ORN, and need for further surgery.

Results: 51 osteocutaneous free flaps were included in the study period. Osteopenia was present in 15 (29%). There was no association between osteopenia and bony nonunion (p = 0.23) or hardware complications (p = 0.85). However, the osteopenic patients did have a higher risk of developing ORN (33%, p = 0.03) when controlling for sex, BMI, and radiation therapy. Of osteopenic patients, 20% required explant with reconstruction due to hardware exposure, chronic osteomyelitis, or ORN. Of the secondary variables, radiation was associated with nonunion when controlling for sex and BMI (p = 0.03).

Conclusions: Osteopenic patients undergoing osteocutaneous free flaps for head and neck cancer did have an increased risk of developing ORN in our cohort when examining long term. This could have implications for more aggressive management of metabolic bone disease or preoperative preventative management.

    Presenting Author(s)

  • Ericka L. Erickson, MD

    Resident Physician
    Ohio State University Wexner Medical Center
    Columbus, Ohio, United States

    Disclosure(s):

    faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.

    • Co-Author(s)

  • Taylor Freeman, MD

    Resident Physician
    The Ohio State University Wexner Medical Center
    Columbus, Ohio, United States

    Disclosure information not submitted.

  • LS

    Lingpeng Shan, MSc

    PhD Candidate
    Ohio State University College of Public Health
    Columbus, OH, United States

    Disclosure(s):

    faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.

  • Lauren E. Miller, MD, MBA

    Assistant Professor of Otolaryngology - Head and Neck Surgery
    The Ohio State University Wexner Medical Center
    Columbus, Ohio, United States

    Disclosure(s):

    faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.

  • Matthew O. Old, MD

    Professor and Director, Otolaryngology Head and Neck Surgery
    The Ohio State University
    Columbus, OH, United States

    Disclosure(s):

    faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.

    • Senior Author(s)

  • Nolan B. Seim, MD, MBA

    Associate Professor
    The Ohio State University Wexner Medical Center and The James Comprehensive Cancer Center
    Columbus, Ohio, United States

    Disclosure(s):

    faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.