Effect of postoperative radiotherapy for free flap volume changing after tongue reconstruction

Yamazaki, Masae; Suzuki, Taiki; Hiraga, Chiho; Yoshida, Yoshifumi; Baba, Akira; Saitou, Hirokazu; Ogane, Satoru; Fujii, Tomohiko; Takano, Masayuki; Katakura, Akira; Tanaka, Ichiro; Nomura, Takeshi; Takano, Nobuo

doi:10.1007/s11282-020-00489-0

Cited by 13 publications

(10 citation statements)

References 22 publications

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“…Several studies have shown that the volume of the flap is further reduced when RT is performed. 11,16,17 In the present study, however, it is encouraging that the group that underwent RT had a significant volume loss, but this was not associated with loss of function. Dynamic reconstruction considering functional aspects is emerging, and our team has shown that the functional outcome is good when dynamic reconstruction is implemented in hemi-tongue reconstruction.…”

Section: Discussionsupporting

confidence: 47%

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A 3-Dimensional Analysis of Flap Volume Change in Hemi-Tongue Reconstruction

et al. 2022

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BackgroundAn adequate volume of the tongue flap is essential to preserve speech and swallowing functions. However, it is generally known that the volume of the free flap tends to decrease over time because of various reasons. Especially in hemi-tongue reconstruction, as half of the normal tongue is retained, some functions are maintained; consequently, there are few studies related to the volume of the flap and function. This study investigated the relationship between flap volume change and function after hemi-tongue reconstruction.MethodsA retrospective chart review of 26 patients who underwent hemi-tongue reconstruction between 2003 and 2020 was performed. Patient demographic data, postoperative radiotherapy (RT), and data on flap types were collected. The volume of the flap was measured by converting the computed tomography and magnetic resonance images into 3 dimensions using the Mimics software. In addition, speech scores and feeding scores were collected.ResultsThe first follow-up computed tomography or magnetic resonance imaging (T1) was performed after an average of 2.09 months, and the second follow-up imaging study (T2) was performed at 16.58 months on average. On average, the T2 volume was 64% of the T1 volume (range, 45.75%–90.54%). Factors including speech and swallowing functions were compared by dividing the group into a group with a more than average decrease in volume (group 1) and a group with a less than average decrease in volume (group 2). In group 1, there were significantly more cases of postoperative RT than in group 2 (85.7%, 50.0%, in group 1 and group 2, respectively; P = 0.049). However, there was no difference in the functional aspects between the 2 groups.ConclusionsThe present study revealed that the flap volume decreased more when RT was performed. However, there was no association between the degree of volume loss and speech and swallowing functions. Regardless of the group, the loss of function was not severe, probably because the remaining half of the tongue was functioning.

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Section: Discussionsupporting

confidence: 47%

“…Several studies have shown that the volume of the flap is further reduced when RT is performed 11,16,17 . In the present study, however, it is encouraging that the group that underwent RT had a significant volume loss, but this was not associated with loss of function.…”

Section: Discussionsupporting

confidence: 46%

A 3-Dimensional Analysis of Flap Volume Change in Hemi-Tongue Reconstruction

et al. 2022

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“…In addition, speech outcomes are linked with the ability of the free flap to contact the hard palate [1,9]. Yamazaki et al examined the effects of postoperative radiation on tongue reconstruction amongst 35 cutaneous and myocutaneous free flaps (MCF) [20]. The study included RFFF, rectus abdominis muscle and ALT with muscle flap.…”

Section: Radiation Considerationsmentioning

confidence: 99%

Free flap volume changes: can we predict ideal flap size and future volume loss?

Dennis

Masheeb

Abouyared

2022

Current Opinion in Otolaryngology &Amp; Head &Amp; Neck Surgery

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Purpose of reviewUnder anticipating free flap volume may lead to deficits in functional and aesthetic outcomes. Alternatively, over anticipating may compromise airway patency, lead to prolonged tracheostomy dependence or poor oral intake, and cause poor cosmetic outcomes. Surgeons face a fine balance in creating a functional reconstruction that accounts adequately for volume changes in the future. Recent findingsRecent studies are elucidating the complex and multifactorial volume changes of free flaps that are dependent on postoperative radiation, flap composition, weight fluctuations, and site of reconstruction. Radial forearm free flaps typically lose about 40% of their volume, regardless of patient-dependent variables. Muscle flaps exhibit significant fluctuations with patient-dependent variables. Adipose-prevalent flaps are likely more resistant to radiation effects but are more dependent on postoperative weight changes in the patient. SummaryFree flap volume over anticipation recommendations range from 1.1 to 1.4 times the final volume to account for future atrophy but patient characteristics including postoperative radiation, anticipated weight loss, and flap composition should be incorporated into intraoperative decisions for final flap volume.

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“… 4 , 6 Furthermore, a robust coverage is required in case of adjuvant radiation therapy, to minimize the risk of postoperative osteroradionecrosis and tissue distortion. 7 – 9 …”

Section: Introductionmentioning

confidence: 99%

“…4,6 Furthermore, a robust coverage is required in case of adjuvant radiation therapy, to minimize the risk of postoperative osteroradionecrosis and tissue distortion. [7][8][9] Mario Cherubino, MD, FEBOPRAS* † Tommaso Baroni, MD* Veronica Santoro, MD* Leonardo Garutti, MD* Paolo Battaglia, MD ‡ Mario Turri-Zanoni, MD ‡ Pietro Di Summa, MD, PhD § Federico Tamborini, MD ‡ Danilo di Giovanna, MD ‡ Luigi Valdatta, FACS* † Abstract Background: Orbital exenteration, the removal of the entire globe, eyelids, and orbital content, is indicated in extensive neoplastic disease involving the orbital region. Although a functional reconstruction of orbital exenteration defects is mandatory, aesthetic concerns need to be considered.…”

Section: Introductionmentioning

confidence: 99%

Social Perception of Reconstruction following Orbital Exenteration

Cherubino

Baroni

Santoro

et al. 2021

Plastic and Reconstructive Surgery - Global Open

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Background: Orbital exenteration, the removal of the entire globe, eyelids, and orbital content, is indicated in extensive neoplastic disease involving the orbital region. Although a functional reconstruction of orbital exenteration defects is mandatory, aesthetic concerns need to be considered. Facial disfigurement following reconstructive surgery often leads to great discomfort and social retirement, which can limit social interaction. The aim of this study was to explore how the society perceives the aspect of patients who underwent orbital exenteration and subsequent reconstruction, comparing two different types of reconstruction: standard anterolateral thigh (ALT) or “sandwich” fascial ALT (SALT) free flap. Methods: An online survey was created based on four questions regarding the perception of reconstruction (discomfort at looking at that patient, perception of unhealthiness, hypothesis of social life impairment, etc); five possible answers were provided, ranging from “completely” to “not at all.” The survey was administered to the general population and to medical students. Results: In total, 255 people participated to the survey (130 medical students and 125 people of the general population); a total of 245 surveys were considered eligible (10 were incomplete and then discharged). Statistical significance was found ( P < 0.001) regarding the better overall appearance of the SALT group over the ALT one. Conclusions: After analysis, the surgical outcome after SALT reconstruction has been found to be less disruptive in both groups, due to a reduced scar burden and a more pleasant orbital pocket. Our results encourage more research in the field of postexenteration reconstruction to achieve more aesthetic and social acceptability.

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Effect of postoperative radiotherapy for free flap volume changing after tongue reconstruction

Cited by 13 publications

References 22 publications

A 3-Dimensional Analysis of Flap Volume Change in Hemi-Tongue Reconstruction

A 3-Dimensional Analysis of Flap Volume Change in Hemi-Tongue Reconstruction

Free flap volume changes: can we predict ideal flap size and future volume loss?

Social Perception of Reconstruction following Orbital Exenteration

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