title: Prior Radiotherapy Does Not Affect Abdominal Wall Reconstruction Outcomes: Evidence from Propensity Score Analysis.
abstract: BACKGROUND
  Prior abdominal wall radiotherapy (XRT) adversely affects wound healing, but data are limited on how prior XRT may affect abdominal wall reconstruction (AWR) outcomes. The purpose of this study was to determine whether prior abdominal wall radiotherapy is associated with a higher incidence of complications following AWR for a hernia or oncologic resection defect.
  
  
  METHODS
  We performed a retrospective study of consecutive patients who underwent complex AWR using acellular dermal matrix (ADM) at a single center. We compared outcomes between patients who underwent prior XRT that directly involved the abdominal wall and those who did not receive XRT. Propensity score match-paired and multivariate analyses were performed.
  
  
  RESULTS
  A total of 511 patients (130 [25.4 %] with prior XRT; 381 [74.6 %] without prior XRT) underwent AWR with ADM for repair of a complex hernia or oncologic resection defect. Mean follow-up was 31.4 months, mean XRT dose was 48.9 Gy, and mean time between XRT and reconstruction was 19.2 months. XRT AWR patients underwent more flap reconstructions (14.6 vs. 5.0 %, P < 0.001) but fewer component separations (61.5 vs. 71.4 %; P = 0.036) than non-XRT AWR patients. The two groups had similar rates of hernia recurrence (8.5 vs. 9.4 %; P = 0.737) and surgical site occurrence (25.4 vs. 23.4 %; P = 0.640). In the propensity score-matched subgroups, there were no differences in hernia recurrence, surgical site occurrence, and wound healing complication rates.
  
  
  CONCLUSIONS
  Prior XRT does not adversely affect outcomes in AWR. However, surgeons should be aware of the higher likelihood of needing a soft tissue flap reconstruction for soft tissue replacement when performing AWR after XRT.
authors.affiliation: Department of Plastic Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
authors.forename: Salvatore
authors.initials: S
authors.lastname: Giordano
authors.affiliation: Department of Plastic Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
authors.forename: Patrick B
authors.initials: PB
authors.lastname: Garvey
authors.affiliation: Department of Plastic Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
authors.forename: Donald P
authors.initials: DP
authors.lastname: Baumann
authors.affiliation: Department of Plastic Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
authors.forename: Jun
authors.initials: J
authors.lastname: Liu
authors.affiliation: Department of Plastic Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA. cbutler@mdanderson.org.
authors.forename: Charles E
authors.initials: CE
authors.lastname: Butler
mesh_terms: D034861:Abdominal Wall / Q000601:surgery*; D062088:Acellular Dermis; D000368:Aged; D016022:Case-Control Studies; D005260:Female; D005500:Follow-Up Studies; D006406:Hematoma / Q000209:etiology; D006547:Hernia / Q000209:etiology; D059685:Herniorrhaphy / Q000009:adverse effects; D006801:Humans; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000601:surgery*; D057216:Propensity Score; D011878:Radiotherapy / Q000009:adverse effects*; D011879:Radiotherapy Dosage; D019651:Plastic Surgery Procedures / Q000009:adverse effects; D012008:Recurrence; D012189:Retrospective Studies; D049291:Seroma / Q000209:etiology; D013524:Surgical Flaps; D013529:Surgical Wound Dehiscence / Q000209:etiology*; D013530:Surgical Wound Infection / Q000209:etiology*; D013997:Time Factors; D014945:Wound Healing / Q000528:radiation effects*