Cargando…
Improved Head and Neck Free Flap Outcome—Effects of a Treatment Protocol Adjustment from Pre- to Postoperative Radiotherapy
BACKGROUND: The impact of preoperative radiotherapy on microvascular reconstructive surgery outcome has been a subject of debate. However, data are conflicting and often dependent on local treatment protocols. We have studied the effects of radiotherapy in a unique, single-center setting where a tre...
Autores principales: | , , , , , |
---|---|
Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Wolters Kluwer Health
2017
|
Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5404438/ https://www.ncbi.nlm.nih.gov/pubmed/28458967 http://dx.doi.org/10.1097/GOX.0000000000001253 |
_version_ | 1783231596043698176 |
---|---|
author | Halle, Martin Eriksson, Bjorn O. Docherty Skogh, Ann-Charlott Sommar, Pehr Hammarstedt, Lalle Gahm, Caroline |
author_facet | Halle, Martin Eriksson, Bjorn O. Docherty Skogh, Ann-Charlott Sommar, Pehr Hammarstedt, Lalle Gahm, Caroline |
author_sort | Halle, Martin |
collection | PubMed |
description | BACKGROUND: The impact of preoperative radiotherapy on microvascular reconstructive surgery outcome has been a subject of debate. However, data are conflicting and often dependent on local treatment protocols. We have studied the effects of radiotherapy in a unique, single-center setting where a treatment protocol change was undertaken from pre- to postoperative radiotherapy administration for microsurgical head and neck reconstructions. METHODS: A cohort study was conducted for 200 consecutive head and neck free flap cases, where 100 were operated on before and 100 after the treatment protocol adjustment in 2006. Only direct cancer reconstructions were included. Complication rates of anastomosis-related (flap necrosis) and flap bed–related (infection, fistula, and wound dehiscence) complications were compared between irradiated and nonirradiated patients. A multivariate analysis was performed to correct for treatment period. RESULTS: One hundred twenty-six patients had received radiotherapy before reconstruction due to cases of cancer recurrence. There were no significant differences in demographic data or risk factors between irradiated and nonirradiated cases. Irradiated cases had a higher rate of both flap loss (9.5% versus 1.4%; P = 0.034) and flap bed–related complications (29% versus 13%; P = 0.014). However, after multivariate analysis, there was only a significant relationship between preoperative irradiation and infection (odds ratio = 2.51; P = 0.033) and fistula formation (odds ratio = 3.13; P = 0.034). CONCLUSIONS: The current single-center study clearly indicates that preoperative radiotherapy is a risk factor for both infection and fistula formation, most likely related to an impaired flap bed. We suggest postoperative radiotherapy administration whenever possible for oncological reasons, otherwise proper antibiotic cover and meticulous flap insetting to prevent radiation-related infection and fistula formation. |
format | Online Article Text |
id | pubmed-5404438 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2017 |
publisher | Wolters Kluwer Health |
record_format | MEDLINE/PubMed |
spelling | pubmed-54044382017-04-28 Improved Head and Neck Free Flap Outcome—Effects of a Treatment Protocol Adjustment from Pre- to Postoperative Radiotherapy Halle, Martin Eriksson, Bjorn O. Docherty Skogh, Ann-Charlott Sommar, Pehr Hammarstedt, Lalle Gahm, Caroline Plast Reconstr Surg Glob Open Original Article BACKGROUND: The impact of preoperative radiotherapy on microvascular reconstructive surgery outcome has been a subject of debate. However, data are conflicting and often dependent on local treatment protocols. We have studied the effects of radiotherapy in a unique, single-center setting where a treatment protocol change was undertaken from pre- to postoperative radiotherapy administration for microsurgical head and neck reconstructions. METHODS: A cohort study was conducted for 200 consecutive head and neck free flap cases, where 100 were operated on before and 100 after the treatment protocol adjustment in 2006. Only direct cancer reconstructions were included. Complication rates of anastomosis-related (flap necrosis) and flap bed–related (infection, fistula, and wound dehiscence) complications were compared between irradiated and nonirradiated patients. A multivariate analysis was performed to correct for treatment period. RESULTS: One hundred twenty-six patients had received radiotherapy before reconstruction due to cases of cancer recurrence. There were no significant differences in demographic data or risk factors between irradiated and nonirradiated cases. Irradiated cases had a higher rate of both flap loss (9.5% versus 1.4%; P = 0.034) and flap bed–related complications (29% versus 13%; P = 0.014). However, after multivariate analysis, there was only a significant relationship between preoperative irradiation and infection (odds ratio = 2.51; P = 0.033) and fistula formation (odds ratio = 3.13; P = 0.034). CONCLUSIONS: The current single-center study clearly indicates that preoperative radiotherapy is a risk factor for both infection and fistula formation, most likely related to an impaired flap bed. We suggest postoperative radiotherapy administration whenever possible for oncological reasons, otherwise proper antibiotic cover and meticulous flap insetting to prevent radiation-related infection and fistula formation. Wolters Kluwer Health 2017-03-30 /pmc/articles/PMC5404438/ /pubmed/28458967 http://dx.doi.org/10.1097/GOX.0000000000001253 Text en Copyright © 2017 The Authors. Published by Wolters Kluwer Health, Inc. on behalf of The American Society of Plastic Surgeons. This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND) (http://creativecommons.org/licenses/by-nc-nd/4.0/) , where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal. |
spellingShingle | Original Article Halle, Martin Eriksson, Bjorn O. Docherty Skogh, Ann-Charlott Sommar, Pehr Hammarstedt, Lalle Gahm, Caroline Improved Head and Neck Free Flap Outcome—Effects of a Treatment Protocol Adjustment from Pre- to Postoperative Radiotherapy |
title | Improved Head and Neck Free Flap Outcome—Effects of a Treatment Protocol Adjustment from Pre- to Postoperative Radiotherapy |
title_full | Improved Head and Neck Free Flap Outcome—Effects of a Treatment Protocol Adjustment from Pre- to Postoperative Radiotherapy |
title_fullStr | Improved Head and Neck Free Flap Outcome—Effects of a Treatment Protocol Adjustment from Pre- to Postoperative Radiotherapy |
title_full_unstemmed | Improved Head and Neck Free Flap Outcome—Effects of a Treatment Protocol Adjustment from Pre- to Postoperative Radiotherapy |
title_short | Improved Head and Neck Free Flap Outcome—Effects of a Treatment Protocol Adjustment from Pre- to Postoperative Radiotherapy |
title_sort | improved head and neck free flap outcome—effects of a treatment protocol adjustment from pre- to postoperative radiotherapy |
topic | Original Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5404438/ https://www.ncbi.nlm.nih.gov/pubmed/28458967 http://dx.doi.org/10.1097/GOX.0000000000001253 |
work_keys_str_mv | AT hallemartin improvedheadandneckfreeflapoutcomeeffectsofatreatmentprotocoladjustmentfrompretopostoperativeradiotherapy AT erikssonbjorno improvedheadandneckfreeflapoutcomeeffectsofatreatmentprotocoladjustmentfrompretopostoperativeradiotherapy AT dochertyskoghanncharlott improvedheadandneckfreeflapoutcomeeffectsofatreatmentprotocoladjustmentfrompretopostoperativeradiotherapy AT sommarpehr improvedheadandneckfreeflapoutcomeeffectsofatreatmentprotocoladjustmentfrompretopostoperativeradiotherapy AT hammarstedtlalle improvedheadandneckfreeflapoutcomeeffectsofatreatmentprotocoladjustmentfrompretopostoperativeradiotherapy AT gahmcaroline improvedheadandneckfreeflapoutcomeeffectsofatreatmentprotocoladjustmentfrompretopostoperativeradiotherapy |