Microvascular Free Flap Outcomes in Maxillectomy Defects from Invasive Fungal Sinusitis

Shilpa M. Rao; P. Daniel Knott; Larissa Sweeny; Aaron Domack; Alice Tang; Rusha Patel; Amy L. Pittman; J. Reed Gardner; Mauricio A. Moreno; Jumin Sunde; Taylor B. Cave; Nicolaus D. Knight; Ben Greene; Patrik Pipkorn; Arjun S. Joshi; Punam Thakkar; Keven Ji; Sara Yang; Brent A. Chang; Mark K. Wax; Carissa M. Thomas

doi:10.1002/lary.31081

Microvascular Free Flap Outcomes in Maxillectomy Defects from Invasive Fungal Sinusitis

Shilpa M. Rao, P. Daniel Knott, Larissa Sweeny, Aaron Domack, Alice Tang, Rusha Patel, Amy L. Pittman, J. Reed Gardner, Mauricio A. Moreno, Jumin Sunde, Taylor B. Cave, Nicolaus D. Knight, Ben Greene, Patrik Pipkorn, Arjun S. Joshi, Punam Thakkar, Keven Ji, Sara Yang, Brent A. Chang, Mark K. WaxCarissa M. Thomas

Research output: Contribution to journal › Article › peer-review

Abstract

Objectives: Microvascular 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. Methods: Retrospective 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. Results: Twenty-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 (±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. Conclusion: Patients 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 Evidence: 4 Laryngoscope, 134:1642–1647, 2024.

Original language	English (US)
Pages (from-to)	1642-1647
Number of pages	6
Journal	Laryngoscope
Volume	134
Issue number	4
DOIs	https://doi.org/10.1002/lary.31081
State	Published - Apr 2024

Keywords

free flap
head and neck reconstruction
invasive fungal sinusitis
mucormycosis
outcomes

ASJC Scopus subject areas

Otorhinolaryngology

Access to Document

10.1002/lary.31081

Cite this

Rao, S. M., Knott, P. D., Sweeny, L., Domack, A., Tang, A., Patel, R., Pittman, A. L., Gardner, J. R., Moreno, M. A., Sunde, J., Cave, T. B., Knight, N. D., Greene, B., Pipkorn, P., Joshi, A. S., Thakkar, P., Ji, K., Yang, S., Chang, B. A., ... Thomas, C. M. (2024). Microvascular Free Flap Outcomes in Maxillectomy Defects from Invasive Fungal Sinusitis. Laryngoscope, 134(4), 1642-1647. https://doi.org/10.1002/lary.31081

Rao, SM, Knott, PD, Sweeny, L, Domack, A, Tang, A, Patel, R, Pittman, AL, Gardner, JR, Moreno, MA, Sunde, J, Cave, TB, Knight, ND, Greene, B, Pipkorn, P, Joshi, AS, Thakkar, P, Ji, K, Yang, S, Chang, BA, Wax, MK & Thomas, CM 2024, 'Microvascular Free Flap Outcomes in Maxillectomy Defects from Invasive Fungal Sinusitis', Laryngoscope, vol. 134, no. 4, pp. 1642-1647. https://doi.org/10.1002/lary.31081

@article{5c282822dcd5416b83a6d9cf1f735fde,

title = "Microvascular Free Flap Outcomes in Maxillectomy Defects from Invasive Fungal Sinusitis",

abstract = "Objectives: Microvascular 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. Methods: Retrospective 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. Results: Twenty-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 (±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. Conclusion: Patients 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 Evidence: 4 Laryngoscope, 134:1642–1647, 2024.",

keywords = "free flap, head and neck reconstruction, invasive fungal sinusitis, mucormycosis, outcomes",

author = "Rao, {Shilpa M.} and Knott, {P. Daniel} and Larissa Sweeny and Aaron Domack and Alice Tang and Rusha Patel and Pittman, {Amy L.} and Gardner, {J. Reed} and Moreno, {Mauricio A.} and Jumin Sunde and Cave, {Taylor B.} and Knight, {Nicolaus D.} and Ben Greene and Patrik Pipkorn and Joshi, {Arjun S.} and Punam Thakkar and Keven Ji and Sara Yang and Chang, {Brent A.} and Wax, {Mark K.} and Thomas, {Carissa M.}",

note = "Publisher Copyright: {\textcopyright} 2023 The American Laryngological, Rhinological and Otological Society, Inc.",

year = "2024",

month = apr,

doi = "10.1002/lary.31081",

language = "English (US)",

volume = "134",

pages = "1642--1647",

journal = "Laryngoscope",

issn = "0023-852X",

publisher = "John Wiley and Sons Inc.",

number = "4",

}

TY - JOUR

T1 - Microvascular Free Flap Outcomes in Maxillectomy Defects from Invasive Fungal Sinusitis

AU - Rao, Shilpa M.

AU - Knott, P. Daniel

AU - Sweeny, Larissa

AU - Domack, Aaron

AU - Tang, Alice

AU - Patel, Rusha

AU - Pittman, Amy L.

AU - Gardner, J. Reed

AU - Moreno, Mauricio A.

AU - Sunde, Jumin

AU - Cave, Taylor B.

AU - Knight, Nicolaus D.

AU - Greene, Ben

AU - Pipkorn, Patrik

AU - Joshi, Arjun S.

AU - Thakkar, Punam

AU - Ji, Keven

AU - Yang, Sara

AU - Chang, Brent A.

AU - Wax, Mark K.

AU - Thomas, Carissa M.

PY - 2024/4

Y1 - 2024/4

N2 - Objectives: Microvascular 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. Methods: Retrospective 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. Results: Twenty-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 (±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. Conclusion: Patients 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 Evidence: 4 Laryngoscope, 134:1642–1647, 2024.

AB - Objectives: Microvascular 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. Methods: Retrospective 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. Results: Twenty-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 (±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. Conclusion: Patients 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 Evidence: 4 Laryngoscope, 134:1642–1647, 2024.

KW - free flap

KW - head and neck reconstruction

KW - invasive fungal sinusitis

KW - mucormycosis

KW - outcomes

UR - http://www.scopus.com/inward/record.url?scp=85173429769&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85173429769&partnerID=8YFLogxK

U2 - 10.1002/lary.31081

DO - 10.1002/lary.31081

M3 - Article

C2 - 37772913

AN - SCOPUS:85173429769

SN - 0023-852X

VL - 134

SP - 1642

EP - 1647

JO - Laryngoscope

JF - Laryngoscope

IS - 4

ER -

Microvascular Free Flap Outcomes in Maxillectomy Defects from Invasive Fungal Sinusitis

Abstract

Keywords

ASJC Scopus subject areas

Access to Document

Other files and links

Fingerprint

Cite this