The Effect of Prior Radiotherapy on Perioperative Complications in Patients Undergoing Free Flap Reconstruction of the Head and Neck
Authors
Dr Paul Rozenbroek (BSc, MD)(1,2), Dr Kevin Nguyen (MBBS, FRACS)(1,3), Dr Tim Manzie (DSc, MBBS, FRACDS)(1,2), A/Prof Sydney Ch’ng (MBBS, PhD, FRACS)(1,2,4), Prof Jonathan R Clark (MBBS, MBiostat, FRACS)(1,2,5), A/Prof Tsu-Hui (Hubert) Low (MBBS, BSc, FRACS) (1,2,6), A/Prof Michael S Elliott (MBBS, MPhil, FRACS) (1,2), Prof Carsten Palme (MBBS, FRACS) (1,2), Dr Luke McPhail (BE, MD)(1), Dr James Wykes (BSci, MBBS, FRACS)(1,2)
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Presenter: Dr Paul Rozenbroek
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Background
Free tissue transfer is standard of care in reconstruction of large defects in the head and neck. Many patients who undergo free flap reconstruction have had prior head and neck radiotherapy (HNRT). The aim of this study is to compare the surgical outcomes of HNRT vs HNRT naïve patients undergoing free flap reconstruction in a large Australian cohort.
Methods
Data from patients who underwent free flap reconstruction of head and neck defects between January 2017 to December 2020 were extracted from a prospectively collated database at Chris O’Brien Lifehouse (Sydney, Australia). Participants were divided into two groups based on whether or not they had HNRT prior to their free flap procedures. Subgroup analysis was performed comparing patients with mucosal defect vs those with cutaneous defect reconstruction.
Results
From a total of 525 patients who had undergone free flap reconstruction, 117 (22.3%) had prior HNRT. Prior HNRT was associated with higher rates of flap complications (14.5% vs 7.8%, p = 0.045), recipient site complications (31.6% vs 21.1%, p = 0.025), and higher Clavien Dindo Classification ( p = 0.040). In the mucosal defect subgroup, prior HNRT was associated with higher rates of flap complications (17.2% vs 7.8%, p < 0.001). In the cutaneous defect subgroup, there was no difference in complication rates between HNRT naïve and those who had prior HNRT.
Conclusion
Prior HNRT increases the risk of both flap and recipient-site complications. However, this mainly occurs in patients undergoing reconstruction of mucosal defects.
Free tissue transfer is standard of care in reconstruction of large defects in the head and neck. Many patients who undergo free flap reconstruction have had prior head and neck radiotherapy (HNRT). The aim of this study is to compare the surgical outcomes of HNRT vs HNRT naïve patients undergoing free flap reconstruction in a large Australian cohort.
Methods
Data from patients who underwent free flap reconstruction of head and neck defects between January 2017 to December 2020 were extracted from a prospectively collated database at Chris O’Brien Lifehouse (Sydney, Australia). Participants were divided into two groups based on whether or not they had HNRT prior to their free flap procedures. Subgroup analysis was performed comparing patients with mucosal defect vs those with cutaneous defect reconstruction.
Results
From a total of 525 patients who had undergone free flap reconstruction, 117 (22.3%) had prior HNRT. Prior HNRT was associated with higher rates of flap complications (14.5% vs 7.8%, p = 0.045), recipient site complications (31.6% vs 21.1%, p = 0.025), and higher Clavien Dindo Classification ( p = 0.040). In the mucosal defect subgroup, prior HNRT was associated with higher rates of flap complications (17.2% vs 7.8%, p < 0.001). In the cutaneous defect subgroup, there was no difference in complication rates between HNRT naïve and those who had prior HNRT.
Conclusion
Prior HNRT increases the risk of both flap and recipient-site complications. However, this mainly occurs in patients undergoing reconstruction of mucosal defects.
