Free fibula mandible reconstruction for osteoradionecrosis is more challenging than for primary cancer

Introduction 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. Methods 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. Results Four‐hundred seventy‐nine patients met the inclusion criteria (168 ORN vs. 311 non‐ORN patients). Propensity‐matching 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‐skin‐island fibula flaps than non‐OR patients (20.8% vs. 5.7%, p