Safety and Effectiveness of Flap Reconstruction in Patients Receiving Intraoperative Radiation Therapy

• DOI: 10.1097/01.gox.0000799520.10723.a8
• Publication Date: 2021-10-23T01:04:15Z
• Authors: Maria Yan; Kuldeep Singh; Sanjna Rajput; Eric Dozois; Peter Rose; Nho Van Tran; Jorys Martinez-Jorge; Ivy A. Petersen; Aparna Vijayasekaran
• Keywords: 03 medical and health sciences; 0302 clinical medicine; RD1-811; Surgery; Reconstructive Abstracts

BACKGROUND: Intraoperative radiation therapy is often used as an adjuvant treatment for locally advanced tumors. Reconstruction of defects after oncological resection challenging. We present the largest cohort to date assessing safety and effectiveness flap reconstruction in these patients. METHODS: A retrospective review patients who underwent intraoperative simultaneous reasons was done. Inclusion criterion 18 years or older this procedure from January 2010 2020 at our institution. RESULTS: total 231 (122 men, 109 women) 244 flaps were included. Mean age surgery 55.5 (SD: 13.2); mean body mass index 28.1 (SD 6.5). Patient comorbidities included active smoking (8.2%), diabetes (16.8%), hypertension (41.4%). Of all patients, 17.7% on chronic anticoagulation, 94% had neoadjuvant therapy, 3.4% 80.2% chemotherapy, 27.2% chemotherapy. dose 12.1 Gy 2.3). Median hospital length-of-stay 7 days (Q1–3: 5–13); median follow-up length 16.4 months 4.5–42.2). Primary tumor colorectal (52.9%), reproductive system (15.6%), extremity (17.2%). In total, 91.8% one 8.9% two flaps. Flap types omental (n = 112), vertical rectus abdominis muscle 61), rotational advancement 16), pedicled gracilis 8), pedicle gastrocnemius 9), free 7). Even though several perioperative complications reported, 91.4% reconstructions successful. Various infectious problems accounted a 60.6% Complications abscess (26.6%), wound infection requiring debridement (22.5%), seroma (12.3%), necrosis (12.7%), cellulitis (11.5%), hematoma (7.4%), full-thickness dehiscence (7.8%). 4.3% bleeding that required blood transfusion, 19% postoperative bleeding, 9% thromboembolic events. flaps, unplanned surgical re-intervention 7.3% hyperbaric oxygen therapy. When comparing with abdominal reconstructions, associated higher odds developing (OR 1.4 (1.4-–140.9), P 0.003). Multiple variables analysis showed obesity increased risk 1.93 (1.02–3.64), 0.04). CONCLUSIONS: safe effective coverage receiving radiotherapy. Postoperative antibiotics beyond usual 24-hour period should be considered. Careful selection critical achieve best outcomes possible.