ALT Rescue Flap With Iliac Crest Bone Graft and Spanning Plate for Mandibular ORN

OBJECTIVE: The mainstay of treatment for full-thickness mandibular osteoradionecrosis (ORN) is segmental mandibulectomy followed by osteocutaneous free flap. We have found success in combining anterolateral thigh rescue flaps with iliac crest bone graft (ICBG) and spanning reconstructive plate for select patients. Our objective is to therefore describe the use, indications, and outcomes of this technique. METHODS: Retrospective chart review of patients at our institution from 1/1/2017 to 10/1/2025. RESULTS: Eight patients (median age: 67, 87.5% male) were included. Pre-operative fracture was noted in six patients; two patients had full thickness destruction evident after debridement. Following the procedure, the median length of stay was 3 days (range: 2-6). There were no episodes of flap takeback or failure. Cessation of symptoms of ORN at most recent follow-up was noted in most patients (n = 6, 75%), with most patients (n = 6, 75%) also demonstrating bony union on follow-up imaging. The median lengths of clinical and radiographic follow up were 25.4 months (range 12.9-84) and 25.2 months (range 6-57.1), respectively. CONCLUSION: Early experience with ALT rescue flap, ICBG, and spanning plate appears to offer an alternative to osteocutaneous free flap reconstruction in select patients with full-thickness mandibular ORN, with low morbidity and abbreviated hospital stays.