• Osseous free flap;
  • microvascular reconstruction;
  • osteoradionecrosis;
  • segmental mandibulectomy;
  • composite resection;
  • vascularized bone-containing free tissue transfer;
  • fibula free flap;
  • maxillomandibular reconstruction


To characterize the changing indications for osseous free flaps in maxillomandibular reconstruction at our institution.

Study Design

Retrospective chart review.


Database review of patients who underwent free-flap reconstruction of the jaws using vascularized bone-containing free tissue transfer from 1995 to 2012 at the University of California Los Angeles (UCLA).


A total of 620 osseous free flaps were performed. The most common indications for surgery were squamous cell carcinoma (n = 442) and osteoradionecrosis (ORN)) of the mandible (n = 73). There were no significant differences in 90-day perioperative complication, flap viability, or mortality rates between any of the indications for surgery. Patients older than 60 years had a higher rate of major perioperative complication (P = 0.0028). ORN cases represented 1.3% ± 1.2% of surgical volume from 1995 to 2000, 8.7% ± 1.8% from 2001 to 2006, and 17.5% ± 2.2% from 2007 to 2012 (P <0.0001). Among cases of ORN, 95.8% of patients had radiation therapy completed at centers outside of our hospital system. For patients with ORN, there was an average interval of 8.7 ± 8.0 years from initiation of radiotherapy to the date of mandibulectomy (range 1–37 years).


The incidence of ORN as an indication for free-flap reconstruction has increased at our institution in recent years. This may reflect an increasing need for the surgical management of medically refractory ORN, a rising awareness or prevalence of ORN overall, and/or increasing comfort with free flaps as a treatment for ORN. Patients who undergo free-flap surgery for ORN do not have greater risks of 90-day perioperative complications or differences in free-flap viability as compared to patients who undergo free-flap reconstruction for other indications.

Level of Evidence

2b. Laryngoscope, 124:1329–1335, 2014