Microvascular Reconstruction of Osteonecrosis: Assessment of Long-term Quality of Life

Larissa Sweeny, Erica Mayland, Brian P. Swendseid, Joseph M. Curry, Alexandra E. Kejner, Carissa M. Thomas, Joshua J. Kain, Steve B. Cannady, Kendall Tasche, Eben L. Rosenthal, Michael DiLeo, Adam J. Luginbuhl, Hailey Theeuwen, Juliana R. Sarwary, Daniel Petrisor, Mark K. Wax

Research output: Contribution to journalArticlepeer-review

10 Scopus citations


Objective: Review long-term clinical and quality-of-life outcomes following free flap reconstruction for osteonecrosis. Study Design: Retrospective multi-institutional review. Setting: Tertiary care centers. Methods: Patients included those undergoing free flap reconstructions for osteonecrosis of the head and neck (N = 232). Data included demographics, defect, donor site, radiation history, perioperative management, diet status, recurrence rates, and long-term quality-of-life outcomes. Quality-of-life outcomes were measured using the University of Washington Quality of Life (UW-QOL) survey. Results: Overall flap success rate was 91% (n = 212). Relative to preoperative diet, 15% reported improved diet function at 3 months following reconstruction and 26% at 5 years. Osteonecrosis recurred in 14% of patients (32/232); median time to onset was 11 months. Cancer recurrence occurred in 13% of patients (29/232); median time to onset was 34 months. Results from the UW-QOL questionnaire were as follows: no pain (45%), minor or no change in appearance (69%), return to baseline endurance level (37%), no limitations in recreation (40%), no changes in swallowing following reconstruction (28%), minor or no limitations in mastication (29%), minor or no speech difficulties (93%), no changes in shoulder function (84%), normal taste function (19%), normal saliva production (27%), generally excellent mood (44%), and no or minimal anxiety about cancer (94%). Conclusion: The majority of patients maintained or had advancement in diet following reconstruction, with low rates of osteonecrosis or cancer recurrence and above-average scores on UW-QOL survey suggesting good return of function and quality of life.

Original languageEnglish (US)
Pages (from-to)636-646
Number of pages11
JournalOtolaryngology - Head and Neck Surgery (United States)
Issue number5
StatePublished - Nov 2021


  • free flap
  • head and neck reconstruction
  • osteonecrosis
  • outcomes
  • quality of life

ASJC Scopus subject areas

  • Surgery
  • Otorhinolaryngology


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