Presenter(s)
S. Ashmeg1, J. D. Smith2, A. Okuribido1, C. T. Wilke3, T. McCaw4, and M. E. Spector5; 1UPMC Hillman Cancer Center, Pittsburgh, PA, 2University of Pittsburgh Medical Center, Pittsburgh, PA, 3Department of Radiation Oncology, University of Pittsburgh Medical Center, Pittsburgh, PA, 4Department of Radiation Oncology, UPMC Hillman Cancer Center, Pittsburgh, PA, 5Department of Otolaryngology, Division of Head and Neck Surgery, UPMC, Pittsburgh, PA
Purpose/Objective(s): Mandibular reconstruction with vascularized bone flaps and fixation hardware is a cornerstone of head and neck oncologic surgery. However, postoperative wound complications, including infection, fistula, plate exposure, and hardware failure, remain common, particularly in patients receiving radiation therapy (RT). While RT is known to impair tissue healing and vascularity, the relationship between radiation dose and specific reconstructive complications is not well defined. This study evaluates whether increasing RT dose predicts wound and plate-related complications following mandibular reconstruction.
Materials/Methods: We performed a retrospective cohort study of 105 patients undergoing mandibular reconstruction. Demographic, oncologic, and treatment variables were collected, including tumor stage, pathology, smoking history, and RT exposure. Most patients received postoperative RT (86), while 19 received preoperative RT. RT dose was analyzed both as a continuous variable and categorically (>60 Gy vs =60 Gy). Outcomes included plate complications (exposure, fracture, failure, removal), wound complications (fistula, soft tissue infection, bony malunion), and recurrence. Continuous RT dose was compared between groups using Wilcoxon rank-sum testing, and categorical comparisons were performed with chi-square testing. The primary endpoint was the association between RT dose and reconstructive complications.
Results: The cohort had a mean age of 60.5 years and was predominantly male (61%). Squamous cell carcinoma accounted for 97 cases. Plate-related complications were common, including exposure (41), fracture (13), failure (10), and removal (39). Wound complications included fistula/bony malunion (11) and soft tissue infection (42).
When RT dose was analyzed as a continuous variable, higher median dose was associated with fistula or soft tissue infection (p = 0.05), plate removal (p = 0.01), and any complication (p = 0.04). When stratified categorically, patients receiving >60 Gy had a significantly higher rate of plate removal (p = 0.006) and a trend toward higher rates of any plate complication (p = 0.07). These findings suggest a dose-dependent relationship between radiation exposure and reconstructive morbidity.Conclusion: Higher RT dose appears to be a meaningful predictor of wound complications and hardware failure following mandibular reconstruction. The association between doses above 60 Gy and plate removal highlights a potential threshold at which reconstructive risk rises substantially. These findings underscore the importance of multidisciplinary treatment planning, consideration of reconstructive strategies that minimize hardware burden, and close postoperative surveillance. Future prospective studies should evaluate whether alternative fixation methods or dose-modifying strategies can reduce complication rates while maintaining oncologic efficacy.