Journal of Plastic, Reconstructive & Aesthetic Surgery
The effect of preoperative radiotherapy on complication rate after microsurgical head and neck reconstruction
Section snippets
Background
Reconstruction of head and neck defects is among the most challenging tasks in plastic surgery. Defects in this anatomic region frequently have devastating consequences as they not only affect appearance but also core aspects of daily life, such as speech, swallowing and mastication. Over the last three decades, microsurgical techniques have established free tissue transfer as the treatment of choice for head and neck reconstruction after radical oncosurgical resection.1, 2 Traditional
Patients and methods
A retrospective cohort study was conducted of all patients who underwent immediate microsurgical reconstruction of post-ablative defects over a 3-year period. The study protocol was approved by the Stanford University Institutional Review Board. The study subjects were divided into two groups: (1) those who did not receive XRT and (2) those who received preoperative external-beam XRT.
Parameters retrieved and analysed included age, gender, co-morbid conditions, tobacco history, presence of
Statistical analysis
Final data analysis was performed in STATA 9.0 (STATA Corporation, College Station, TX, USA, 2006). Exploratory analyses of continuous data included histograms, means and standard deviations for normally distributed data and medians and interquartile ranges (IQRs) for non-normally distributed data. Normality of the continuous variables was confirmed with the Shapiro–Wilks test using a critical p-value of 0.05. For categorical data, tables were generated showing frequencies and percentages.
Results
A total of 60 patients were included in this study (group 1: 26 patients; group 2: 34 patients) with a mean age of 54.5 years (group 1) and 59.8 years (group 2) (p = 0.15). Patient characteristics are presented in Table 1. In both patient subsets, a predominance of male patients was noted with 15 (58%) and 21 (62%) male patients in groups 1 and 2, respectively (p = 0.75). No difference was observed with regard to smoking habits. Twelve patients in group 1 (46.2%) and 16 patients in group 2 (47.1%)
Discussion
The detrimental effects of XRT on wound healing has been reported, as a result of chronic vascular damage.14, 15, 16 Although this is seemingly a sound concept, it has not been unanimously supported by actual clinical experience.13, 17 In a retrospective cohort study, Choi et al. evaluated whether XRT resulted in an increased rate of local complications after microvascular head and neck reconstruction.12 A total of 100 patients undergoing free fibular flap reconstruction of the mandible were
Conclusion
Our data suggest that preoperative XRT is associated with a significant increase in postoperative flap-related complications. However, these did not result in a prolonged hospital stay reflecting the fact that the majority of flap-related complications can be managed on an outpatient basis. Although microsurgical reconstruction is frequently successful, patients with a history of XRT should be informed preoperatively about their increased risk of complications.
Conflict of interest/funding
None.
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2020, American Journal of Otolaryngology - Head and Neck Medicine and SurgeryCitation Excerpt :Reconstruction of large composite head and neck defects, especially in a previously radiated field, is challenging and poses a high risk for wound complications. In this setting, the rate of flap-related complications in microvascular free tissue transfers has been reported to range between 40 and 56%, with dehiscence, fistula, hematoma, infection, and fibrosis being among the most common complications [1–3]. One significant problem that must often be addressed at the time of primary reconstruction is unfilled dead space, which leads to the collection of stagnant fluid, and in turn, can result in surgical site infection (SSI).