title: Pedicle versus free flap reconstruction in patients receiving intraoperative brachytherapy.
abstract: Introduction This study compared complication rates between pedicle flaps and free flaps used for resurfacing of intraoperative brachytherapy (IOBT) implants placed following head and neck tumour extirpation to help clarify the ideal reconstructive procedure for this scenario. Patients and methods A retrospective review of reconstructions with IOBT at our institution was conducted. Patient and treatment details were recorded, as were the number and type of flap complications, including re-operations. Logistic regressions compared complications between flap groups. Results Fifty free flaps and 55 pedicle flaps were included. On multivariate analysis, free flap reconstruction with IOBT was significantly associated with both an increased risk of having any flap complication (OR = 2.9, p = 0.037) and with need for operative revision (OR = 3.5, p = 0.048) compared to pedicle flap reconstruction. Conclusions In the setting of IOBT, free flaps are associated with an increased risk of having complications and requiring operative revisions.
authors.affiliation: a Section of Plastic and Reconstructive Surgery , Yale University School of Medicine , New Haven , CT , USA ;
authors.forename: Erik J
authors.initials: EJ
authors.lastname: Geiger
authors.affiliation: a Section of Plastic and Reconstructive Surgery , Yale University School of Medicine , New Haven , CT , USA ;
authors.forename: Bryce A
authors.initials: BA
authors.lastname: Basques
authors.affiliation: a Section of Plastic and Reconstructive Surgery , Yale University School of Medicine , New Haven , CT , USA ;
authors.forename: Christopher C
authors.initials: CC
authors.lastname: Chang
authors.affiliation: b Department of Radiation Oncology , Yale University School of Medicine , New Haven , CT , USA ;
authors.forename: Yung
authors.initials: Y
authors.lastname: Son
authors.affiliation: c Section of Otolaryngology , Yale University School of Medicine , New Haven , CT , USA.
authors.forename: Clarence T
authors.initials: CT
authors.lastname: Sasaki
authors.affiliation: a Section of Plastic and Reconstructive Surgery , Yale University School of Medicine , New Haven , CT , USA ;
authors.forename: Andrew
authors.initials: A
authors.lastname: McGregor
authors.affiliation: a Section of Plastic and Reconstructive Surgery , Yale University School of Medicine , New Haven , CT , USA ;
authors.forename: Stephan
authors.initials: S
authors.lastname: Ariyan
authors.affiliation: a Section of Plastic and Reconstructive Surgery , Yale University School of Medicine , New Haven , CT , USA ;
authors.forename: Deepak
authors.initials: D
authors.lastname: Narayan
mesh_terms: D000368:Aged; D001918:Brachytherapy; D003131:Combined Modality Therapy; D005260:Female; D058752:Free Tissue Flaps / Q000009:adverse effects; D006258:Head and Neck Neoplasms / Q000532:radiotherapy / Q000601:surgery*; D006801:Humans; D007430:Intraoperative Care; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011183:Postoperative Complications; D012086:Reoperation; D012189:Retrospective Studies; D013524:Surgical Flaps / Q000009:adverse effects
keywords: Brachytherapy; free flap; head and neck cancer; pedicle flap; reconstruction