Impact of preoperative and intraoperative management on outcomes in osteoradionecrosis requiring free flap reconstruction.

Abstract

BACKGROUND:

Perioperative management of advanced osteoradionecrosis of the head and neck requiring free flap (FF) reconstruction varies. Our objectives included assessment of practice patterns and outcomes.

METHODS:

Multi-institutional, retrospective review of FF reconstruction for head and neck osteoradionecrosis (n = 260).

RESULTS:

Administration of preoperative antibiotics did not correlate with reduction in postoperative complications. Preoperative alcohol use correlated with higher rates of hardware exposure (p = 0.03) and 30-day readmission (p = 0.04). Patients with FF compromise had higher TSH (p = 0.04) and lower albumin levels (p = 0.005). Prealbumin levels were lower in patients who required neck washouts (p = 0.02) or a second FF (p = 0.03). TSH levels were higher in patients undergoing postoperative debridement (p = 0.03) or local flap procedures (p = 0.04).

CONCLUSION:

Malnutrition, hypothyroidism, and substance abuse correlated with a higher incidence of postoperative wound complications in patients undergoing FF reconstruction for advanced osteoradionecrosis. Preoperative antibiotics use did not correlate with a reduction in postoperative wound complications.

• Authors: Erica Mayland, Joseph M Curry, Mark K Wax, Carissa M Thomas, Brian P Swendseid, Alexandra E Kejner, Joshua J Kain, Steven B Cannady, Brett A Miles, Michael DiLeo, Caitlin McMullen, Kendall Tasche, Rocco M Ferrandino, Juliana Sarwary, Daniel Petrisor, Larissa Sweeny
• Journal: Head & neck (Head Neck) Vol. 44 Issue 3 Pg. 698-709 (03 2022) ISSN: 1097-0347 [Electronic] United States
• PMID: 34918862 (Publication Type: Journal Article, Multicenter Study)
• Copyright: © 2021 Wiley Periodicals LLC.

Topics

• Free Tissue Flaps (adverse effects)
• Head and Neck Neoplasms (complications, radiotherapy, surgery)
• Humans
• Osteoradionecrosis (etiology, surgery)
• Postoperative Complications (etiology)
• Plastic Surgery Procedures (methods)
• Retrospective Studies