Introduction

New research highlights a promising approach using the ALT rescue flap ORN technique to manage full-thickness mandibular osteoradionecrosis. Traditionally, surgeons treat this condition with segmental mandibulectomy followed by an osteocutaneous free flap. However, this retrospective review suggests that combining an anterolateral thigh (ALT) rescue flap with an iliac crest bone graft (ICBG) and a spanning plate offers a viable alternative. Consequently, this method provides significant clinical benefits for specific patient populations requiring reconstruction.

Clinical Indications and Surgical Technique

Notably, this technique targets patients with full-thickness mandibular destruction or fractures resulting from radiation. The procedure begins with thorough debridement to remove necrotic bone. Subsequently, surgeons harvest an iliac crest bone graft to restore mandibular height. They then apply a spanning reconstructive plate to maintain structural integrity. Finally, the ALT flap imports vascularized tissue to the site, which facilitates healing. Furthermore, this "rescue" approach avoids the high morbidity often linked to more extensive fibular free flaps.

Success of ALT rescue flap ORN Technique

The results from the institutional review show highly encouraging data. For instance, the study included eight patients with a median age of 67 years. Most patients experienced complete cessation of symptoms following the procedure. Additionally, 75% of patients showed radiographic evidence of bony union during the follow-up period. Perhaps most importantly, the median hospital stay was only three days. Therefore, this protocol minimizes the recovery burden on both patients and healthcare facilities.

Advantages Over Conventional Methods

In contrast to traditional osteocutaneous free flaps, this method reduces operative complexity significantly. Because it utilizes a non-vascularized bone graft within a vascularized soft tissue envelope, it simplifies the harvest process. Moreover, the abbreviated hospital stay suggests lower perioperative risks. Consequently, this technique appears particularly useful for older patients or those with significant comorbidities. Ultimately, surgeons should consider this rescue strategy as a primary option for select mandibular defects.

Frequently Asked Questions

What makes a patient a candidate for an ALT rescue flap?

Clinicians typically select patients with full-thickness mandibular osteoradionecrosis who may not tolerate more invasive reconstructive surgeries. It is particularly effective when local debridement reveals significant bony loss but where a rescue approach remains feasible.

How does this procedure impact hospital recovery time?

This technique significantly reduces recovery time compared to standard bone flaps. Research indicates a median stay of just three days, allowing patients to return home much sooner than traditional methods usually permit.

Disclaimer: This content is for informational and educational purposes only. It does not constitute medical advice or a professional relationship. Refer to the latest local and national guidelines for clinical practice.

References

1. Vos DJ et al. ALT Rescue Flap With Iliac Crest Bone Graft and Spanning Plate for Mandibular ORN. Laryngoscope. 2026 Feb 14. doi: 10.1002/lary.70440. PMID: 41689432.


2. Fritz MA et al. Evaluation of Anterolateral Thigh Fascia Lata Rescue Flap for Mandibular Osteoradionecrosis. JAMA Otolaryngol Head Neck Surg. 2023;149(7):612-618.


3. Haffey TT et al. Mandibular rescue: Application of the ALT fascia free flap to arrest osteoradionecrosis of the mandible. Am J Otolaryngol. 2019;40(6):102263.