(0506) Anterolateral Thigh Fascia Flap for Treatment of Medication-Related Osteonecrosis of the Jaw

Introduction: Medication-related osteonecrosis of the jaw (MRONJ) is a rare but devastating complication associated with the use of anti-angiogenic or anti-resorptive therapy, resulting in non-healing exposed mandibular bone. Treatment of MRONJ ranges from conservative measures such as hyperbaric oxygen (HBO) to invasive treatment in the form of segmental resection and reconstruction with free vascularized bone. At our institution, we routinely perform anterolateral thigh fascia lata (ALTFL) free flap for arrest of mandibular osteoradionecrosis with significant success. We have since expanded this technique for use in MRONJ in appropriately selected patients and report our experience with this technique.

Methods: A retrospective chart review of all patients who underwent ALTFL free flap for MRONJ at our institution from January 1, 2013 – August 31, 2023 was conducted.

Results: In total, 5 patients (median age 71, 60% male) with MRONJ underwent ALTFL free flap over the 10-year study period. MRONJ was attributed to anti-resorptive therapy in each patient within this cohort, with a median length of anti-resorptive use of 33 months. The majority of patients (n = 3, 60%) had failed conservative management with antibiotic therapy. The most commonly affected mandibular subsites included the body (n = 5), parasymphysis (n = 4), and angle (n = 2). Necrotic bone segments removed at time of operation ranged from 5-10 cm in length and 1.5-2 cm in vertical height. Microvascular anastomosis was performed in a minimal access approach utilizing the superficial temporal (n = 2) and facial vessels (n = 3). Following ALTFL free flap, the median length of stay was 3 days (range: 2-6). There were no postoperative complications reported in this cohort of patients. Each patient demonstrated clinical and radiographic arrest of MRONJ without progression of symptoms. No patients required additional mandibular debridement or free tissue transfer. Average follow up was 11.2 months.

Conclusions: ALTFL offers an effective, durable technique for the arrest of MRONJ, with low patient morbidity and abbreviated hospital stays.