Microvascular Free Flap Outcomes in Maxillectomy Defects from Invasive Fungal Sinusitis

被引：1

作者：

Rao, Shilpa M. ^{[1
]}

Knott, P. Daniel ^{[2
]}

Sweeny, Larissa ^{[3
]}

Domack, Aaron ^{[4
]}

Tang, Alice ^{[4
]}

Patel, Rusha

Pittman, Amy L. ^{[5
,6
]}

Gardner, J. Reed ^{[7
]}

Moreno, Mauricio A. ^{[7
]}

Sunde, Jumin ^{[7
]}

Cave, Taylor B. ^{[8
]}

Knight, Nicolaus D. ^{[1
]}

Greene, Ben ^{[1
]}

Pipkorn, Patrik ^{[9
]}

Joshi, Arjun S. ^{[10
]}

Thakkar, Punam ^{[10
]}

Ji, Keven ^{[11
]}

Yang, Sara ^{[11
]}

Chang, Brent A. ^{[8
]}

Wax, Mark K. ^{[11
]}

Thomas, Carissa M. ^{[1
]}

机构：

[1] Univ Alabama Birmingham, Dept Otolaryngol Head & Neck Surg, 1720 2nd AveSouth, Birmingham, AL 35294 USA

[2] Univ Calif San Francisco, Med Ctr, Dept Otolaryngol Head & Neck Surg, San Francisco, CA USA

[3] Univ Miami, Dept Otolaryngol Head & Neck Surg, Miami, FL USA

[4] Univ Cincinnati, Dept Otolaryngol Head & Neck Surg, Cincinnati, OH USA

[5] Univ Oklahoma, Dept Otolaryngol Head & Neck Surg, Hlth Sci Ctr, Oklahoma City, OK USA

[6] Loyola Univ Med Ctr, Dept Otolaryngol Head & Neck Surg, Chicago, IL USA

[7] Univ Arkansas Med Sci, Dept Otolaryngol Head & Neck Surg, Little Rock, AR USA

[8] Mayo Clin Arizona, Dept Otolaryngol Head & Neck Surg, Scottsdale, AZ USA

[9] Washington Univ, Dept Otolaryngol Head & Neck Surg, St Louis, MO USA

[10] George Washington Univ, Div Otolaryngol Head & Neck Surg, Washington, DC USA

[11] Oregon Hlth & Sci Univ, Dept Otolaryngol Head & Neck Surg, Sch Med, Portland, OR USA

来源：

LARYNGOSCOPE | 2024年 / 134卷 / 04期

关键词：

head and neck reconstruction; free flap; invasive fungal sinusitis; mucormycosis; outcomes; CLASSIFICATION-SYSTEM; FROZEN-SECTION; RECONSTRUCTION; RHINOSINUSITIS; MANAGEMENT; EXPERIENCE; DIAGNOSIS; ALGORITHM; SURVIVAL; MAXILLA;

D O I：

10.1002/lary.31081

中图分类号：

R-3 [医学研究方法]; R3 [基础医学];

学科分类号：

1001 ;

摘要：

ObjectivesMicrovascular free tissue transfer is routinely used for reconstructing midface defects in patients with malignancy, however, studies regarding reconstructive outcomes in invasive fungal sinusitis (IFS) are lacking. We aim to describe outcomes of free flap reconstruction for IFS defects, determine the optimal time to perform reconstruction, and if anti-fungal medications or other risk factors of an immunocompromised patient population affect reconstructive outcomes.MethodsRetrospective review of reconstruction for IFS (2010-2022). Age, BMI, hemoglobin A1c, number of surgical debridements, and interval from the last debridement to reconstruction were compared between patients with delayed wound healing versus those without. Predictor variables for delayed wound healing and the effect of time on free flap reconstruction were analyzed.ResultsTwenty-seven patients underwent free flap reconstruction for IFS. Three patients were immunocompromised from leukemia and 21 had diabetes mellitus (DM). Patients underwent an average of four surgical debridements for treatment of IFS. The interval from the last IFS debridement to flap reconstruction was 5.58 months (& PLUSMN;5.5). Seven flaps (25.9%) had delayed wound healing. A shorter interval of less than 2 months between the last debridement for IFS and reconstructive free flap procedure was associated with delayed wound healing (Fisher Exact Test p = 0.0062). Other factors including DM, BMI, HgA1c, and bone reconstruction were not associated with delayed wound healing.ConclusionPatients with maxillectomy defects from IFS can undergo microvascular-free flap reconstruction with good outcomes while on anti-fungal medication. Early reconstruction in the first 2 months after the last IFS debridement is associated with delayed wound healing.Level of EvidenceIV Laryngoscope, 2023 A multi-institutional study to determine the microvascular-free flap outcomes and ideal timing for free flap reconstruction in patients with midface defects resulting from invasive fungal sinusitis.image

引用

页码：1642 / 1647

页数：6

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