Reconstruction of Osteoradionecrosis of Malar and Maxillary Bone Using Thoracodorsal Artery Perforator Flap Combined With Scapular Bone: 14-Year Follow-Up

Osteoradionecrosis (ORN) of the maxilla is relatively uncommon. To the authors' knowledge, no previous reports have described reconstruction of malar and maxillary ORN using a thoracodorsal artery perforator flap combined with scapular bone. This flap has been used in oncologic resection, craniofacial dysplasia, and trauma, and it is also suitable for ORN reconstruction. The authors report a case involving a 60-year-old woman who developed malar and maxillary ORN 3 years after chemoradiotherapy for maxillary sinus carcinoma. The defect was reconstructed using this chimeric free flap, with additional correction of the lower eyelid for aesthetic refinement. A subsequent minor revision requested by the patient, using non-vascularized tissue, resulted in local infection that required drainage. Although this led to contour irregularity, further surgical correction achieved satisfactory cosmesis. At more than 14 years postoperatively, the flap remained stable without significant bony resorption. The authors present the long-term clinical course and surgical considerations of this rare case.