title: Impact of Specialty Training on the Association between Flap Size and Incidence of Complications following Microvascular Head and Neck Reconstruction for Cancer.
abstract: BACKGROUND
  The scope of otolaryngology and plastic surgery overlap within head and neck reconstruction is increasing; yet comparative outcome studies between these two subspecialties are limited.
  
  
  METHODS
  A retrospective review was performed on all patients who underwent microvascular reconstruction of a postablative head and neck defect at a quaternary academic medical center between January 2000 and October 2011. Postoperative outcomes were reviewed by subspecialty and Mann-Whitney analysis was used to investigate any flap size differences between cohorts with and without complications.
  
  
  RESULTS
  A consecutive series of 129 (66.8%) otolaryngology cases and 64 (33.2%) plastic surgery cases comprised the entire study sample. Plastic surgery flaps were significantly larger than otolaryngology flaps (9.7 vs. 8.5 cm, p = 0.004). Flap complication rates (31.8 vs. 37.5%, p = 0.429) and flap failure rates (5.4 vs. 4.7%, p = 0.429) were comparable between subspecialties. However, a significant difference in flap size was evident between the cohorts with and without flap complications following microvascular reconstruction by otolaryngology (9.18 vs. 8.15 cm, p = 0.042). This difference was not detected following reconstruction by plastic surgery (9.34 vs. 9.04 cm, p = 0.225). For the overall sample, there was a correlation between increasing flap size and higher tumor stages (significant at T4, p = 0.003) as well as advanced T-stage and medical complications (p = 0.004).
  
  
  CONCLUSIONS
  Plastic surgeons should maintain an active role in the reconstruction of complex, microvascular head and neck cases such as those that require larger flaps and/or of advanced T-stages.
authors.affiliation: Department of Plastic and Reconstructive Surgery, Lahey Hospital and Medical Center, Burlington, Massachusetts.
authors.forename: Anaeze C
authors.initials: AC
authors.lastname: Offodile
authors.affiliation: Department of Plastic and Reconstructive Surgery, Lahey Hospital and Medical Center, Burlington, Massachusetts.
authors.forename: Andrew S
authors.initials: AS
authors.lastname: Aherrera
authors.affiliation: Department of Nephrology, Massachusetts General Hospital, Boston, Massachusetts.
authors.forename: Julia
authors.initials: J
authors.lastname: Wenger
authors.affiliation: Department of Surgery, Brigham and Women's Hospital, Boston, Massachusetts.
authors.forename: Thomas
authors.initials: T
authors.lastname: Tsai
authors.affiliation: Department of Surgery, Brigham and Women's Hospital, Boston, Massachusetts.
authors.forename: Dennis P
authors.initials: DP
authors.lastname: Orgill
authors.affiliation: Department of Plastic and Reconstructive Surgery, Lahey Hospital and Medical Center, Burlington, Massachusetts.
authors.forename: Lifei
authors.initials: L
authors.lastname: Guo
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006258:Head and Neck Neoplasms / Q000473:pathology / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D010036:Otolaryngology / Q000193:education*; D011379:Prognosis; D019651:Plastic Surgery Procedures / Q000009:adverse effects; D012189:Retrospective Studies; D013518:Surgery, Plastic / Q000193:education*; D013524:Surgical Flaps; D016896:Treatment Outcome