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Peer-reviewedCC BY 4.0Frontiers in Oncology

Outcomes of sequential microvascular tissue transfer for radiation induced sequelae post mandibular reconstruction

  • Karnav Panchal1
  • Sagnika Ukil1
  • Neha Kalwadia1
  • Saugata Samadder1
  • Kapila Manikantan1
  • Pattatheyil Arun1
  • Vikram D. Kekatpure1
  • Prateek V. Jain1
  • Guru Charan Sahu1
  1. 1Department of Plastic, Reconstructive and Microsurgery, TATA Medical Center
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Abstract

Background: Radiotherapy-related complications following mandibular reconstruction remain a major challenge in head and neck oncologic reconstruction. Although free fibula flap reconstruction has become the gold standard for segmental mandibular defects, delayed radiation-induced sequelae such as hardware exposure, contour deformity, soft tissue atrophy, fistula formation continue to affect long-term outcomes. Literature regarding the role of sequential microvascular tissue transfer in managing these complications remains limited.

Objectives: This study aims to evaluate the indications, surgical planning, recipient vessel selection, and outcomes of sequential microvascular free tissue transfer performed for radiation-induced sequelae after mandibular reconstruction.

Materials and methods: A retrospective observational study was conducted between June 2024 and December 2025 at a tertiary referral center. Patients who had previously undergone primary mandibular reconstruction using a fibula free flap followed by adjuvant radiotherapy and later developed radiation-related complications requiring secondary microvascular reconstruction were included. Demographic data, primary reconstructive details, radiation parameters, duration between radiation and complication, indications for sequential reconstruction, flap characteristics, recipient vessel selection, postoperative complications, and healing outcomes were analyzed.

Results: Ten patients were included in the study. All patients had undergone primary fibula free flap reconstruction following segmental mandibulectomy followed by sequential microvascular soft tissue reconstruction for radiation induced complications. Ipsilateral superficial temporal vessels were used as recipient vessels in all cases without using vein grafts. All flaps survived completely. Satisfactory wound healing and contour restoration were achieved in all patients.

Conclusion: Sequential microvascular reconstruction represents a reliable and effective strategy for managing radiation-induced complications following mandibular reconstruction. Volume loss can be addressed during plate removal surgery which not only achieves a stable soft tissue cover but also prevents further progression to osteoradionecrosis.

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Cite

BibTeXRIS
BibTeX
@article{panchal2026outcomes,
  title = {{Outcomes of sequential microvascular tissue transfer for radiation induced sequelae post mandibular reconstruction}},
  author = {Karnav Panchal and Sagnika Ukil and Neha Kalwadia and Saugata Samadder and Kapila Manikantan and Pattatheyil Arun and Vikram D. Kekatpure and Prateek V. Jain and Guru Charan Sahu},
  journal = {Frontiers in Oncology},
  year = {2026},
  month = oct,
  doi = {10.3389/fonc.2026.1897431},
  url = {https://www.frontiersin.org/articles/10.3389/fonc.2026.1897431/full},
  note = {CC BY 4.0},
}
RIS
TY  - JOUR
TI  - Outcomes of sequential microvascular tissue transfer for radiation induced sequelae post mandibular reconstruction
AU  - Karnav Panchal
AU  - Sagnika Ukil
AU  - Neha Kalwadia
AU  - Saugata Samadder
AU  - Kapila Manikantan
AU  - Pattatheyil Arun
AU  - Vikram D. Kekatpure
AU  - Prateek V. Jain
AU  - Guru Charan Sahu
PY  - 2026
DA  - 2026/10/23
JO  - Frontiers in Oncology
DO  - 10.3389/fonc.2026.1897431
UR  - https://www.frontiersin.org/articles/10.3389/fonc.2026.1897431/full
AB  - Background: Radiotherapy-related complications following mandibular reconstruction remain a major challenge in head and neck oncologic reconstruction. Although free fibula flap reconstruction has become the gold standard for segmental mandibular defects, delayed radiation-induced sequelae such as hardware exposure, contour deformity, soft tissue atrophy, fistula formation continue to affect long-term outcomes. Literature regarding the role of sequential microvascular tissue transfer in managing these complications remains limited.  Objectives: This study aims to evaluate the indications, surgical planning, recipient vessel selection, and outcomes of sequential microvascular free tissue transfer performed for radiation-induced sequelae after mandibular reconstruction.  Materials and methods: A retrospective observational study was conducted between June 2024 and December 2025 at a tertiary referral center. Patients who had previously undergone primary mandibular reconstruction using a fibula free flap followed by adjuvant radiotherapy and later developed radiation-related complications requiring secondary microvascular reconstruction were included. Demographic data, primary reconstructive details, radiation parameters, duration between radiation and complication, indications for sequential reconstruction, flap characteristics, recipient vessel selection, postoperative complications, and healing outcomes were analyzed.  Results: Ten patients were included in the study. All patients had undergone primary fibula free flap reconstruction following segmental mandibulectomy followed by sequential microvascular soft tissue reconstruction for radiation induced complications. Ipsilateral superficial temporal vessels were used as recipient vessels in all cases without using vein grafts. All flaps survived completely. Satisfactory wound healing and contour restoration were achieved in all patients.  Conclusion: Sequential microvascular reconstruction represents a reliable and effective strategy for managing radiation-induced complications following mandibular reconstruction. Volume loss can be addressed during plate removal surgery which not only achieves a stable soft tissue cover but also prevents further progression to osteoradionecrosis.
SN  - 2234-943X
ER  -