Halle Martin, Eriksson Bjorn O, Docherty Skogh Ann-Charlott, Sommar Pehr, Hammarstedt Lalle, Gahm Caroline
Department of Plastic and Reconstructive Surgery, Karolinska University Hospital, Stockholm, Sweden; †Department of Molecular Medicine and Surgery, Karolinska Institute, Stockholm, Sweden, Stockholm, Sweden; ‡Department of Clinical Sciences Intervention and Technology, Karolinska Institute, Stockholm, Sweden; and §Department of ENT Head & Neck Surgery, Karolinska University Hospital, Stockholm, Sweden.
Plast Reconstr Surg Glob Open. 2017 Mar 30;5(3):e1253. doi: 10.1097/GOX.0000000000001253. eCollection 2017 Mar.
The impact of preoperative radiotherapy on microvascular reconstructive surgery outcome has been a subject of debate. However, data are conflicting and often dependent on local treatment protocols. We have studied the effects of radiotherapy in a unique, single-center setting where a treatment protocol change was undertaken from pre- to postoperative radiotherapy administration for microsurgical head and neck reconstructions.
A cohort study was conducted for 200 consecutive head and neck free flap cases, where 100 were operated on before and 100 after the treatment protocol adjustment in 2006. Only direct cancer reconstructions were included. Complication rates of anastomosis-related (flap necrosis) and flap bed-related (infection, fistula, and wound dehiscence) complications were compared between irradiated and nonirradiated patients. A multivariate analysis was performed to correct for treatment period.
One hundred twenty-six patients had received radiotherapy before reconstruction due to cases of cancer recurrence. There were no significant differences in demographic data or risk factors between irradiated and nonirradiated cases. Irradiated cases had a higher rate of both flap loss (9.5% versus 1.4%; = 0.034) and flap bed-related complications (29% versus 13%; = 0.014). However, after multivariate analysis, there was only a significant relationship between preoperative irradiation and infection (odds ratio = 2.51; = 0.033) and fistula formation (odds ratio = 3.13; = 0.034).
The current single-center study clearly indicates that preoperative radiotherapy is a risk factor for both infection and fistula formation, most likely related to an impaired flap bed. We suggest postoperative radiotherapy administration whenever possible for oncological reasons, otherwise proper antibiotic cover and meticulous flap insetting to prevent radiation-related infection and fistula formation.
术前放疗对微血管重建手术结果的影响一直是争论的焦点。然而，数据相互矛盾，且往往取决于当地的治疗方案。我们在一个独特的单中心环境中研究了放疗的影响，在该环境中，对头颈部显微外科重建手术的放疗管理从术前改为术后。
对连续200例头颈部游离皮瓣病例进行队列研究，其中100例在2006年治疗方案调整前接受手术，100例在调整后接受手术。仅纳入直接癌症重建病例。比较接受放疗和未接受放疗患者的吻合口相关（皮瓣坏死）和皮瓣床相关（感染、瘘管和伤口裂开）并发症的发生率。进行多变量分析以校正治疗时期。
由于癌症复发，126例患者在重建前接受了放疗。接受放疗和未接受放疗的病例在人口统计学数据或风险因素方面无显著差异。接受放疗的病例皮瓣丢失率（9.5%对1.4%；P = 0.034）和皮瓣床相关并发症发生率（29%对13%；P = 0.014）均较高。然而，多变量分析后，术前放疗与感染（优势比 = 2.51；P = 0.033）和瘘管形成（优势比 = 3.13；P = 0.034）之间仅存在显著关系。
当前的单中心研究清楚地表明，术前放疗是感染和瘘管形成的危险因素，很可能与皮瓣床受损有关。出于肿瘤学原因，我们建议尽可能进行术后放疗，否则应给予适当的抗生素覆盖并细致进行皮瓣植入，以预防与放疗相关的感染和瘘管形成。
