Osteoradionecrosis and microvascular free flap failure managed with negative pressure wound therapy: A case report

Michael J. Gigliotti, Neel Patel, Caroline McLaughlin, Alexis Rothermel, Cathy Henry, Elias Rizk

Research output: Contribution to journalComment/debatepeer-review

2 Scopus citations


A 56-year-old female with a history of meningioma status post subtotal resection (Simpson grade IV) and extensive radiation therapy presented with osteoradionecrosis (O.R.N.) managed previously with a microvascular free flap (MVFF). The evaluation revealed worsening O.R.N. and a scalp defect of 15 × 10 cm. The patient underwent MVFF reconstruction utilizing a free latissimus muscle flap covered by meshed split-thickness skin graft (STSG). Her surgery was complicated by delayed free flap failure and Serratia marcescens growth, which occurred sometime after discharge from the hospital. This was managed with removal of the free muscle flap and skin graft, serial debridement’s, antibiotics, and replacements of a synthetic dural matrix and negative pressure wound therapy (NPWT). Once a clean wound bed was again obtained, the patient underwent fasciocutaneous anterolateral thigh (A.L.T.) MVFF reconstruction, which was complicated by left hypoglossal nerve injury, dehiscence of the flap inset, and dehiscence of the neck access incision requiring revision surgery. On the last follow-up 2 weeks after her surgery, the patient had 100% flap viability and a 2 × 1.5 cm on the left parietal aspect of the flap healing be secondary intent. We demonstrate that NPWT is successful in managing open calvarial wounds due to O.R.N.

Original languageEnglish (US)
Pages (from-to)1938-1943
Number of pages6
JournalBritish Journal of Neurosurgery
Issue number6
StatePublished - 2023

All Science Journal Classification (ASJC) codes

  • Surgery
  • Clinical Neurology


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