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envelopes the outer cortex of the bone and provides the superficial cortex with nutrients. The cortex should
also be evaluated for viability. The cortex of healthy bone is dense, typically white in color, and will have
visible bright red bleeding from trans-cortical capillaries. In addition, the bone marrow should be evaluated
for viability. Healthy bone marrow is able to maintain its trabecular structure and will bleed bright red. Any
bone which does not appear viable should be removed until viable bone is confirmed.

CONCLUSIONS
ORN is one of the most crippling complications following radiation for head and neck malignancies. The
development of ORN has a significant impact on quality of life, leaving patients with disabling pain and
chronic wounds. Free flap reconstruction is an integral part of the definitive management of advanced
ORN. Although often effective at treating ORN, there remains a risk for postoperative wound complications
and functional decline. Informed discussions with patients regarding expectations and anticipated outcomes
and careful preoperative planning are essential in treating these complex cases.

DECLARATIONS
Authors’ contributions
Made substantial contributions to conception and design of the study, analysis and interpretation,
composition of manuscript, and final approval of manuscript: Sweeny L, Mayland EJ

Availability of data and materials
Not applicable.

Financial support and sponsorship
None.

Conflicts of interest
Both authors declared that there are no conflicts of interest.

Ethical approval and consent to participate
Not applicable.

Consent for publication
Not applicable.

Copyright
© The Author(s) 2021.

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