title: Feasibility and Outcomes of the Third or More Episodes of Sequential Microvascular Reconstruction for Recurrent or Second Primary Oral Cancer.
abstract: This study was a robust examination of the clinical outcomes and technical feasibility of sequential microvascular reconstruction for recurrent or second primary oral cancer.
  
  
  
  A retrospective, cross-sectional analysis of adult patients undergoing microvascular reconstruction of head and neck oncologic defects was performed at Chang Gung Memorial Hospital, spanning 10 years. The patients were divided into three groups as follows: first episode, second episode, and third or more episodes of reconstruction. Demographics, operative details, and clinical outcomes were compared.
  
  
  
  The study cohort included 3186, 319, and 62 patients who respectively received first, second, and third or more episodes of reconstruction. The most common tumor sites were the tongue (36.9 %) and the buccal region (36.8 %), with squamous cell carcinoma as the prevalent histology. The anterior lateral thigh was the most popular donor site used (76.1 %). The third or more episodes of microvascular reconstruction were associated with an increased incidence of flap failure (8.1 %) relative to the first (1.9 %; p = 0.003) and the second (1.6 %; p = 0.01) episodes. Re-exploration of venous occlusion (9.7 vs. 3.2 %), neck wound infections (53.2 vs. 35.5 %), fistula (17.7 vs. 8.1 %), and hospital stay (28.9 ± 14.6 vs. 25.3 ± 10.1) also showed significantly higher values for the third or more episodes group than for the first episode group.
  
  
  
  Sequential microvascular reconstruction for recurrent or second primary oral cancer is associated with an increased incidence of postoperative complications. However, in appropriate candidates for repeat ablation, microvascular reconstruction remains the gold standard for attaining functional and cosmetic outcomes.
authors.affiliation: Department of Plastic Surgery, Lahey Hospital and Medical Center, Burlington, MA, USA.
authors.forename: Anaeze C
authors.initials: AC
authors.lastname: Offodile
authors.affiliation: Department of Otolaryngology-Head & Neck Surgery, Chang Gung Memorial Hospital & Chang Gung University College of Medicine, Taoyuan, Taiwan.
authors.forename: Kai-Ping
authors.initials: KP
authors.lastname: Chang
authors.affiliation: Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital & Chang Gung University College of Medicine, Taoyuan, Taiwan.
authors.forename: Hsin-Hung
authors.initials: HH
authors.lastname: Chen
authors.affiliation: Tufts University School of Medicine, Boston, MA, USA.
authors.forename: Eric
authors.initials: E
authors.lastname: Loesch
authors.affiliation: Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital & Chang Gung University College of Medicine, Taoyuan, Taiwan.
authors.forename: Shao-Yu
authors.initials: SY
authors.lastname: Hung
authors.affiliation: Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital & Chang Gung University College of Medicine, Taoyuan, Taiwan. kai3488@gmail.com.
authors.forename: Huang-Kai
authors.initials: HK
authors.lastname: Kao
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002294:Carcinoma, Squamous Cell / Q000601:surgery*; D003430:Cross-Sectional Studies; D017050:Episode of Care; D005240:Feasibility Studies; D005260:Female; D005402:Fistula / Q000209:etiology* / Q000601:surgery; D006801:Humans; D007902:Length of Stay; D008297:Male; D055806:Microvessels / Q000601:surgery*; D008875:Middle Aged; D009062:Mouth Neoplasms / Q000601:surgery*; D009364:Neoplasm Recurrence, Local / Q000601:surgery*; D016609:Neoplasms, Second Primary / Q000601:surgery*; D019651:Plastic Surgery Procedures / Q000009:adverse effects*; D012086:Reoperation; D012189:Retrospective Studies; D013524:Surgical Flaps / Q000098:blood supply*; D013530:Surgical Wound Infection / Q000209:etiology / Q000601:surgery; D016896:Treatment Outcome; D055815:Young Adult