Fibula flap versus soft tissue flap with reconstruction plate for mandibular stage 3 medication-related osteonecrosis of the jaw: a retrospective cohort study

With the increasing incidence of medication-related osteonecrosis of the jaw (MRONJ), the choice of reconstruction method for mandibular stage 3 MRONJ remains controversial. This study aimed to compare the outcomes of fibula flap (FF) and soft tissue flap with reconstruction plate (SR) in patients with mandibular stage 3 MRONJ. This retrospective cohort study included patients diagnosed with mandibular stage 3 MRONJ who underwent reconstruction between September 2018 and May 2024. Patients were categorized into the FF and SR groups. Demographic and general characteristics, intraoperative and postoperative outcomes, and oral health-related quality of life (OHRQoL) were compared between the two groups. Microsurgical outcomes of the FF group were also analyzed. A total of 29 patients (17 FF vs. 12 SR) were analyzed. The operative time was significantly shorter in the SR group (P < 0.001). A lower rate of wound-related complications and a greater improvement in OHRQoL were observed in the FF group compared to the SR group, although the differences were not statistically significant (P > 0.05). The FF group achieved significantly better plate-related complication-free survival (HR = 0.12, 95% CI = 0.02–0.62, P = 0.019), with no significant effect on overall survival (HR = 0.74, 95% CI = 0.13–4.31, P = 0.712). In the FF group, successful bone healing was achieved in 16 patients, primary healing at the donor site was observed in 15 patients, and the mean lower extremity functional scale (LEFS) score was 60.2 ± 7.0. FF reconstruction shows better plate-related complication-free survival compared to SR, with satisfactory outcomes in mandibular stage 3 MRONJ.