Influence of preoperative radiotherapy on head and neck free‐flap reconstruction: Systematic review and meta‐analysis

Mijiti, Ainiwaer; Kuerbantayi, Nazuke; Zhang, Zhi Q.; Su, Ming; Zhang, Xiao H.; Muhetaer, Huojia

doi:10.1002/hed.26136

Cited by 38 publications

(26 citation statements)

References 44 publications

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“…The rates of microvascular compromise were similar in both groups, with 1/21 and 2/49 in the simultaneous and sequential groups, respectively, and are consistent with those reported in the literature 31 . Well‐documented risk factors known to correlate with free flap compromise including prior radiotherapy, smoking status, and bony reconstructions were present in both groups 32–35 . Donor site wound complication rates were similar for both groups and were in keeping with what has been previously described for this free flap donor region 36 .…”

Section: Discussionsupporting

confidence: 88%

Synchrony in head and neck surgery: Feasibility and outcomes of simultaneous scapular free flap reconstruction

et al. 2021

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Background The scapula free flap is a versatile option in head and neck reconstruction but is less amenable to simultaneous harvest and ablation. Methods Retrospective series (2015–2021) of consecutive scapula flaps. Cases categorized as simultaneous versus sequential, compared for operative time, oncological and patient‐reported outcomes. Results Seventy consecutive scapula free flaps were performed (n = 21 simultaneous, n = 49 sequential). Mandible reconstruction was performed in 51.0% and 61.9% of sequential and simultaneous cases, respectively; 49.0% and 38.1% addressed bony maxillary defects. Simultaneous surgery reduced operative time by 37.9% (151 min, p < 0.00001) and there were fewer tracheostomies performed (p < 0.005). Rates of positive margins and free flap compromise were equivalent (n = 1, 4.8% vs. n = 2, 4.1%). There was no difference in patient‐reported outcomes. Conclusions This series demonstrates feasibility, efficacy, and outcomes of bony scapula reconstruction of maxillofacial defects comparing simultaneous and sequential approaches. Benefits of the two‐team approach are highlighted including decreased operative time.

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Section: Discussionsupporting

confidence: 88%

Synchrony in head and neck surgery: Feasibility and outcomes of simultaneous scapular free flap reconstruction

et al. 2021

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“…In this context, a positive history of radiation therapy is a known risk factor for complications [42,43] that has led us to adapt the concept of double free flap reconstructions [12,44]. In a recent systematic review and meta-analysis, Mijiti et al demonstrated an odds ratio of 1.90 that suggests a significantly increased rate for fistula formation [45]. On the other hand, the development of wound dehiscence or plate exposure was not significantly associated with a positive history of radiation.…”

Section: Impact Of Total Radiation Dosage On the Occurrence Of Complimentioning

confidence: 99%

Retrospective analysis of complications in 190 mandibular resections and simultaneous reconstructions with free fibula flap, iliac crest flap or reconstruction plate: a comparative single centre study

et al. 2020

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Objectives The purpose of this study was to evaluate the incidence of complications following mandibular reconstruction and to analyse possible contributing factors. Materials and methods Clinical data and computed tomography scans of all patients who needed a mandibular reconstruction with a reconstruction plate, free fibula flap (FFF) or iliac crest (DCIA) flap between August 2010 and August 2015 were retrospectively analysed. Results One hundred and ninety patients were enrolled, encompassing 77 reconstructions with reconstruction plate, 89 reconstructions with FFF and 24 reconstructions with DCIA flaps. Cutaneous perforation was most frequently detected in the plate subgroup within the early interval and overall (each p = 0.004). Low body mass index (BMI) and total radiation dosage were the most relevant risk factors for the development of analysed complications. Conclusions Microvascular bone flaps have overall less skin perforation than reconstruction plates. BMI and expected total radiation dosage have to be respected in choice of reconstructive technique. Clinical relevance A treatment algorithm for mandibular reconstructions on the basis of our results is presented.

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“…Additionally, extensive tumors carry a risk of a defect healing after radiotherapy, especially if they cause a connection between the oral cavity and the facial skin. In those cases, a primary surgical approach to restore the anatomic integrity of the oral cavity and the facial skin appears sensible for obvious aesthetic and functional reasons, because there is plethora of publications on the higher complication rate of reconstructive surgical approaches in patients with a history of radiotherapy [ 22 , 23 , 24 ].…”

Section: Discussionmentioning

confidence: 99%

Full-Thickness Tumor Resection of Oral Cancer Involving the Facial Skin—Microsurgical Reconstruction of Extensive Defects after Radical Treatment of Advanced Squamous Cell Carcinoma

Moratin

Mrosek

Horn

et al. 2021

Cancers

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Advanced tumors of the head and neck are challenging for the treatment specialist due to the need to synergize oncological and functional requirements. Free flap reconstruction has been established as the standard of care for defects following tumor resection. However, depending on the affected anatomic subsite, advanced tumors may impose specific difficulties regarding reconstruction, especially when full-thickness resection is required. This study aimed to evaluate reconstructive strategies and oncological outcomes in patients with full-thickness resection of the oral cavity. A total of 33 patients with extensive defects due to squamous cell carcinoma of the oral cavity were identified. Indications, reconstructive procedures, and clinical outcome were evaluated. Thirty-two patients (97%) presented locally advanced tumors (T3/T4). Complete tumor resection was achieved in 26 patients (78.8%). The anterolateral thigh flap was the most frequently used flap (47.1%), and the primary flap success rate was 84.8%. The cohort demonstrated a good local control rate and moderate overall and progression-free survival rates. Most patients regained full competence regarding oral alimentation and speech. Full-thickness tumor resections of the head and neck area may be necessary due to advanced tumors in critical anatomic areas. In many cases, radical surgical treatment leads to good oncological results. Free flap reconstruction has been shown to be a suitable option for extensive defects in aesthetically challenging regions.

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Influence of preoperative radiotherapy on head and neck free‐flap reconstruction: Systematic review and meta‐analysis

Cited by 38 publications

References 44 publications

Synchrony in head and neck surgery: Feasibility and outcomes of simultaneous scapular free flap reconstruction

Synchrony in head and neck surgery: Feasibility and outcomes of simultaneous scapular free flap reconstruction

Retrospective analysis of complications in 190 mandibular resections and simultaneous reconstructions with free fibula flap, iliac crest flap or reconstruction plate: a comparative single centre study

Full-Thickness Tumor Resection of Oral Cancer Involving the Facial Skin—Microsurgical Reconstruction of Extensive Defects after Radical Treatment of Advanced Squamous Cell Carcinoma

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