Free flap surgery in osteoradionecrosis of the head and neck

: Osteoradionecrosis (ORN) following radiation therapy is a much-feared complication of the treatment head and neck cancer. Free flap reconstruction in ORN patient has specific challenges for surgeon. From 2014 to 2020 Head Neck Microvascular unit Oral Maxillofacial Surgery Division at Jackson Health/University Miami treated 149 patients with free reconstruction. The fibula (n=65) anterior lateral thigh (6n=1) were workhorse flaps our series comprising 44% 41% total surgeries. A 13 cases (8.7%) involved performing 2 same operation. Thirty had recorded complications one loss (0.7%) case partial necrosis flap. most common encountered congestion 8 (5%), 5 dehiscence,4 hematoma (2.6%) 3 infection site (3%). average length stay was 8.2 days. In this paper we present approach these lessons have learned. Though surgery complex greater risks than “virgin” neck, experience demonstrates that good outcomes can be achieved consistently structured approach.