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  1. Article ; Online: The maxillary artery as a recipient vessel option for complex midface and anterior skull base microsurgical repair: A cadaveric study.

    Assam, Jed H / Quinn, Thomas H / Militsakh, Oleg N

    Microsurgery

    2017  Volume 37, Issue 6, Page(s) 611–617

    Abstract: Introduction: Variations in the operative situation for complex head and neck defect reconstructions resulting from mechanisms such as trauma, oncologic resection, and prior radiation exposure can result in situations of a vessel-depleted neck. This ... ...

    Abstract Introduction: Variations in the operative situation for complex head and neck defect reconstructions resulting from mechanisms such as trauma, oncologic resection, and prior radiation exposure can result in situations of a vessel-depleted neck. This requires an awareness of alternate, innovative options for use in reconstructive repairs. The purpose of this study was to provide characterization of the third segment of the maxillary artery necessary to consider its use as a recipient vessel in free flap repair of complex midface defects.
    Materials and methods: Seventeen cadaver hemifaces were used for anatomic demonstration of the maxillary artery third segment by a transmaxillary approach to obtain descriptive measures for statistical analysis.
    Results: The average artery intraluminal cross-section diameter was obtained for the sphenopalatine (1.39 ± 0.12 mm) descending palatine (0.94 ± 0.10 mm), and terminal maxillary (1.68 ± 0.17 mm) arterial vessels. The mean transmaxillary depth with was (43 ± 1.2 mm). Mean mobilizable lengths for sphenopalatine, descending palatine, and terminal maxillary arteries were (30 ± 2 mm), (29 ± 2 mm), and (20 ± 2 mm), accordingly. Vessel patterns were characterized using Morton and Kahn classification for sphenopalatine-descending palatine bifurcation as well as the Kwak classification for maxillary artery third segment morphology.
    Conclusions: In situations where primary recipient vessel sites are unavailable, the maxillary artery represents an innovative option to be considered with suitable recipient artery characteristics.
    MeSH term(s) Aged ; Aged, 80 and over ; Cadaver ; Dissection ; Free Tissue Flaps/blood supply ; Free Tissue Flaps/transplantation ; Head and Neck Neoplasms/surgery ; Humans ; Maxillary Artery/anatomy & histology ; Maxillary Artery/transplantation ; Microsurgery/methods ; Reconstructive Surgical Procedures/methods
    Language English
    Publishing date 2017-09
    Publishing country United States
    Document type Journal Article
    ZDB-ID 605524-2
    ISSN 1098-2752 ; 0738-1085
    ISSN (online) 1098-2752
    ISSN 0738-1085
    DOI 10.1002/micr.30095
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  2. Article ; Online: Quality of Life and Depression Symptoms After Therapy De-Escalation in HPV+ Oropharyngeal Squamous Cell Carcinoma: A Nonrandomized Controlled Trial.

    Panwar, Aru / Shah, Swapnil / Reid, Abigail E / Lydiatt, William / Holcomb, Andrew J / Osmolak, Angela / Coughlin, Andrew / Militsakh, Oleg / Su, Yungpo B / Mirmiran, Alireza / Huang, Tien-Shew / Nolan, Nicole / Duckert, Randall / Barney, Christian / Chiu, Max / Nguyen, Cam / Sayles, Harlan / Ganti, Apar Kishor / Lindau, Robert

    JAMA otolaryngology-- head & neck surgery

    2024  

    Abstract: Importance: Despite interest in therapy de-escalation for survivors of human papillomavirus-mediated oropharyngeal squamous cell carcinoma (HPV-positive OPSCC), the association of de-escalated therapy with patient-reported quality of life (QoL) outcomes ...

    Abstract Importance: Despite interest in therapy de-escalation for survivors of human papillomavirus-mediated oropharyngeal squamous cell carcinoma (HPV-positive OPSCC), the association of de-escalated therapy with patient-reported quality of life (QoL) outcomes and burden of depressive symptoms remains unclear.
    Objective: To identify associations between clinicopathologic and therapeutic variables with patient-reported QoL outcomes and depression symptom burden in patients with HPV-positive OPSCC, who were enrolled in a therapy de-escalation trial.
    Design, setting, and participants: In this nonrandomized controlled, open-label, curative-intent therapy de-escalation clinical trial in adults with stage I, II, and III HPV-positive OPSCC, patients were recruited from a high-volume head and neck oncology practice.
    Main outcomes and measures: The main outcomes of this study included quantitative, patient-reported QoL and depression symptoms per well-validated inventories. Patient-reported QoL was based on Functional Assessment of Cancer Therapy-Head & Neck (FACT-HN) scores (range, 0-148; lower score indicates inferior QoL). Patient-reported depression-related symptom burden was based on Quick Inventory of Depressive Symptomatology-Self-Report (QIDS-SR) scores (range, 0-27; a higher score indicates a higher burden of depression symptoms). Baseline clinicopathologic and treatment variables were paired with FACT-HN and QIDS-SR scores at baseline, 3, 6, 12, 24, and 36 months. Linear mixed-effect models with a random intercept were used for each participant and fixed effects for other measures. Regression coefficients are reported with 95% CIs.
    Results: A total of 95 patients were followed up for a median (IQR) of 2.2 (1.6-3.2) years. Of these, 93 patients (98%) were male with a mean (SD) age of 60.5 (8.2) years. Overall, 54 participants (57%) had a history of current or former smoking, 47 (50%) underwent curative-intent surgery (with or without adjuvant therapy), and 48 (50%) underwent primary radiotherapy (with or without chemotherapy). The median (IQR) radiotherapy dose was 60 (60-70) Gy. Five deaths and 2 recurrence events were observed (mean [SD] recurrence interval, 1.4 [1.5] years). A higher radiotherapy dose was the only modifiable factor associated with inferior patient-reported QoL (lower FACT-HN) (coefficient, -0.66 [95% CI, -1.09 to -0.23]) and greater burden of depression-related symptoms (higher QIDS-SR) (coefficient, 0.11 [95% CI, 0.04-0.19]). With the 70-Gy dose as reference, improvements in FACT-HN and QIDS-SR scores were identified when patients received 51 to 60 Gy (coefficient, 12.75 [95% CI, 4.58-20.92] and -2.17 [-3.49 to -0.85], respectively) and 50 Gy or lower (coefficient, 15.03 [4.36-25.69] and -2.80 [-4.55 to -1.04]).
    Conclusions and relevance: In this nonrandomized controlled, open-label, curative-intent therapy de-escalation trial, a higher radiotherapy dose was associated with inferior patient-reported QoL and a greater burden of depression-related symptoms. This suggests opportunities for improved QoL outcomes and reduced depression symptom burden with a reduction in radiotherapy dose.
    Trial registration: ClinicalTrials.gov Identifier: NCT04638465.
    Language English
    Publishing date 2024-04-04
    Publishing country United States
    Document type Journal Article
    ZDB-ID 2701825-8
    ISSN 2168-619X ; 2168-6181
    ISSN (online) 2168-619X
    ISSN 2168-6181
    DOI 10.1001/jamaoto.2024.0262
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  3. Article ; Online: Initial psychometric testing of the Head and Neck Cancer Patient Self-Management Inventory (HNC-PSMI).

    Bond, Stewart M / Schumacher, Karen / Dietrich, Mary S / Wells, Nancy / Militsakh, Oleg / Murphy, Barbara A

    European journal of oncology nursing : the official journal of European Oncology Nursing Society

    2020  Volume 47, Page(s) 101751

    Abstract: Purpose: Head and neck cancer (HNC) and its treatment are associated with significant symptom burden and functional impairment. HNC patients must engage in intensive and complex self-management protocols to minimize acute and late treatment effects. ... ...

    Abstract Purpose: Head and neck cancer (HNC) and its treatment are associated with significant symptom burden and functional impairment. HNC patients must engage in intensive and complex self-management protocols to minimize acute and late treatment effects. Self-management among HNC patients is understudied due to the limited availability of disease-specific self-management measures. This article describes the initial psychometric testing of the HNC Patient Self-Management Inventory (HNC-PSMI), an instrument that characterizes self-management tasks in the HNC population.
    Method: A cross-sectional survey design was used. One hundred HNC patients completed the HNC-PSMI, the Vanderbilt Head and Neck Cancer Symptom Survey plus General Symptom Survey, and the Profile of Mood States-Short Form. To evaluate the psychometric properties of the HNC-PSMI, the relevance of items, internal consistency of domain item responses, and the direction and strength of associations between domain scores and other measures were examined.
    Results: There was variability both in the number of self-management tasks performed overall and in each domain as well as in the reported difficulty completing those tasks. Kuder-Richardson values for domains with > 3 items ranged from 0.61 to 0.86. Hypothesized associations were supported.
    Conclusions: Overall, the psychometric properties for the HNC-PSMI were acceptable. The HNC-PSMI can be used to advance an understanding of self-management requirements and challenges in HNC patients.
    MeSH term(s) Aged ; Cross-Sectional Studies ; Female ; Head and Neck Neoplasms/therapy ; Humans ; Male ; Middle Aged ; Psychometrics/instrumentation ; Reproducibility of Results ; Self-Management/psychology ; Surveys and Questionnaires
    Language English
    Publishing date 2020-05-04
    Publishing country Scotland
    Document type Journal Article
    ZDB-ID 2017117-1
    ISSN 1532-2122 ; 1462-3889
    ISSN (online) 1532-2122
    ISSN 1462-3889
    DOI 10.1016/j.ejon.2020.101751
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  4. Article ; Online: De-Novo Depression, Prophylactic Antidepressant, and Survival in Patients With Head and Neck Cancer.

    Panwar, Aru / McGill, Trevon / Lydiatt, Daniel / Militsakh, Oleg / Lindau, Robert / Coughlin, Andrew / Sayles, Harlan / Smith, Russell / Lydiatt, William

    The Laryngoscope

    2022  Volume 133, Issue 4, Page(s) 856–862

    Abstract: ... were evaluable and were randomly allocated to prophylactic escitalopram oxalate (n = 60) or placebo (n ...

    Abstract Objective: To study the association between the development of moderate or greater depression during curative-intent therapy and overall survival (OS) in patients with stages II-IV head and neck cancer (HNC).
    Methods: In this secondary analysis of a randomized double-blind placebo-controlled trial, of 148 eligible participants diagnosed with stages II-IV HNC but without baseline depression, 125 were evaluable and were randomly allocated to prophylactic escitalopram oxalate (n = 60) or placebo (n = 65). Participants were followed for development of moderate or greater depression, using Quick Inventory of Depressive Symptomatology-Self Report (QIDS-SR, range 0-27, score ≥11 indicated moderate or greater depression), and were stratified by demographics; cancer site and stage; and primary treatment modality (surgery with or without radiotherapy vs. radiotherapy with or without chemotherapy). Single variable and multivariable Cox proportional-hazard models were used to evaluate differences in OS.
    Results: Clinically significant depression developed in 22 of 125 patients (17.6%) during HNC treatment. The mean follow-up was 5.0 years (SD 2.4). OS was similar for patient groups, when stratified by development of moderate or greater depression (HR 0.54 [CI, 0.21-1.43]) or use of prophylactic antidepressant (HR 0.64 [CI, 0.34-1.21]).
    Conclusion: There was no significant association between OS and development of moderate or greater depression in patients being treated for stages II-IV HNC, or between OS and use of prophylactic antidepressant escitalopram. Prophylactic antidepressant may be considered in patients with HNC for prevention of clinically significant depression and may offer improved quality of life outcomes.
    Level of evidence: 2 Laryngoscope, 133:856-862, 2023.
    MeSH term(s) Humans ; Depression/etiology ; Depression/prevention & control ; Quality of Life ; Antidepressive Agents/therapeutic use ; Head and Neck Neoplasms/drug therapy
    Chemical Substances Antidepressive Agents
    Language English
    Publishing date 2022-06-22
    Publishing country United States
    Document type Randomized Controlled Trial ; Journal Article ; Research Support, N.I.H., Extramural ; Research Support, Non-U.S. Gov't
    ZDB-ID 80180-x
    ISSN 1531-4995 ; 0023-852X
    ISSN (online) 1531-4995
    ISSN 0023-852X
    DOI 10.1002/lary.30249
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  5. Article ; Online: Rehabilitation of a parotidectomy patient--a systematic approach.

    Militsakh, Oleg N / Sanderson, Jeremy A / Lin, Derrick / Wax, Mark K

    Head & neck

    2013  Volume 35, Issue 9, Page(s) 1349–1361

    Abstract: Parotidectomy is a common surgical procedure. Resultant contour defect, Frey's syndrome, and facial nerve rehabilitation deserve special consideration. Microsurgical techniques provide unparallel advantage for reconstruction of large-volume defects. Same- ...

    Abstract Parotidectomy is a common surgical procedure. Resultant contour defect, Frey's syndrome, and facial nerve rehabilitation deserve special consideration. Microsurgical techniques provide unparallel advantage for reconstruction of large-volume defects. Same-stage reconstruction of the defect is advocated and often beneficial to the patient. The importance of full communication between the extirpative and reconstructive surgeon cannot be underscored. Often, institutional and personal biases must be overcome to provide best quality care for the patient. This article provides a comprehensive review of the medical literature on the subject and contrives a systematic approach to the use of various reconstructive techniques.
    MeSH term(s) Humans ; Parotid Diseases/surgery ; Postoperative Complications ; Reconstructive Surgical Procedures/methods ; Reconstructive Surgical Procedures/rehabilitation ; Surgical Flaps ; Treatment Outcome
    Language English
    Publishing date 2013-09
    Publishing country United States
    Document type Journal Article ; Review
    ZDB-ID 645165-2
    ISSN 1097-0347 ; 0148-6403 ; 1043-3074
    ISSN (online) 1097-0347
    ISSN 0148-6403 ; 1043-3074
    DOI 10.1002/hed.23095
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  6. Article ; Online: Mandibulectomy and free flap reconstruction for bisphosphonate-related osteonecrosis of the jaws.

    Hanasono, Matthew M / Militsakh, Oleg N / Richmon, Jeremy D / Rosenthal, Eben L / Wax, Mark K

    JAMA otolaryngology-- head & neck surgery

    2013  Volume 139, Issue 11, Page(s) 1135–1142

    Abstract: ... reconstruction after serial irrigation and debridement. The overall complication rate was 46% (n = 6 ...

    Abstract Importance: Bisphosphonate-related osteonecrosis of the jaws is an increasingly recognized complication of intravenous and oral bisphosphonate therapy. Our experience suggests that mandibulectomy and free flap reconstruction is an effective treatment for patients with stage 3 and recalcitrant stage 2 disease.
    Objective: To analyze indications for segmental mandibulectomy and microvascular free flap reconstruction for bisphosphonate-related osteonecrosis of the jaws and surgical outcomes following this procedure.
    Design, setting, and participants: In a multi-institutional case series study conducted in academic tertiary care centers, 13 patients underwent segmental mandibulectomy and microvascular free flap reconstruction, including 8 patients with stage 3 disease and 5 patients with recalcitrant stage 2 disease. All patients had persistent or progressive disease despite conservative oral care and antibiotic treatment.
    Interventions: Segmental mandibulectomy and microvascular free flap reconstruction.
    Main outcomes and measures: Treatment efficacy and postoperative complications. RESULTS There was 1 total flap loss due to infection. The patient with a flap loss ultimately underwent a successful fibula osteocutaneous free flap reconstruction after serial irrigation and debridement. The overall complication rate was 46% (n = 6). All complications occurred in patients with stage 3 disease. Ultimately, all patients achieved a successful reconstruction, with no recurrences. All patients tolerated a soft or regular diet postoperatively.
    Conclusions and relevance: Bisphosphonate-related osteonecrosis of the jaws is an increasingly recognized complication of intravenous and oral bisphosphonate therapy that can occasionally progress to involve full-thickness mandibular destruction, pathologic fracture, and fistulization, as well as chronic pain and infection. Mandibulectomy and free flap reconstruction is an effective treatment for patients with stage 3 and recalcitrant stage 2 bisphosphonate-related osteonecrosis of the jaws. High rates of chronic infection and underlying medical comorbidities may predispose to a substantial perioperative complication rate.
    MeSH term(s) Aged ; Bisphosphonate-Associated Osteonecrosis of the Jaw/surgery ; Bone Transplantation/methods ; Female ; Fibula/transplantation ; Follow-Up Studies ; Free Tissue Flaps ; Humans ; Male ; Mandible/surgery ; Mandibular Osteotomy/methods ; Middle Aged ; Reconstructive Surgical Procedures/methods ; Retrospective Studies ; Treatment Outcome
    Language English
    Publishing date 2013-11
    Publishing country United States
    Document type Comparative Study ; Journal Article ; Multicenter Study
    ZDB-ID 2701825-8
    ISSN 2168-619X ; 2168-6181
    ISSN (online) 2168-619X
    ISSN 2168-6181
    DOI 10.1001/jamaoto.2013.4474
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  7. Article ; Online: Outcomes of the osteocutaneous radial forearm free flap for mandibular reconstruction.

    Arganbright, Jill M / Tsue, Terance T / Girod, Douglas A / Militsakh, Oleg N / Sykes, Kevin J / Markey, Jeff / Shnayder, Yelizaveta

    JAMA otolaryngology-- head & neck surgery

    2013  Volume 139, Issue 2, Page(s) 168–172

    Abstract: Importance: Limited donor and recipient site complications support the osteocutaneous radial forearm free flap (OCRFFF) for mandibular reconstruction as a useful option for single-stage mandibular reconstruction.: Objective: To examine and report ... ...

    Abstract Importance: Limited donor and recipient site complications support the osteocutaneous radial forearm free flap (OCRFFF) for mandibular reconstruction as a useful option for single-stage mandibular reconstruction.
    Objective: To examine and report long-term outcomes and complications at the donor and recipient sites for patients undergoing the OCRFFF for mandibular reconstruction.
    Design: Retrospective review.
    Setting: Academic, tertiary care medical center.
    Patients: The study population comprised 167 consecutive patients who underwent single-staged mandibular reconstruction with an OCRFFF.
    Mean outcome measures: Rates of complications at the donor and recipient sites.
    Results: The mean patient age was 61 years (range, 20-93 years). Men compromised 68% of the population. Follow-up interval ranged from 2 to 99 months (mean, 25.9 months). The median length of bone harvested was 7 cm (range, 2.5-12.0 cm). Prophylactic plating was completed for each of the radii at the time of harvest. Donor site complications included radial fracture (1 patient [0.5%]), tendon exposure (47 patients [28%]), and donor hand weakness or numbness (13 patients [9%]). Recipient site complications included mandible hardware exposure (29 patients [17%]), mandible nonunion or malunion (4 patients [2%]), and mandible bone or hardware fracture (4 patients [2%]). Using regression analysis, we found that patients were 1.3 times more likely to have plate exposure for every increase of 1 cm of bone harvest length; this was statistically significant (P = .04).
    Conclusions and relevance: This is the largest single study reporting outcomes and complications for patients undergoing OCRFFF for mandibular reconstruction. Prophylactic plating of the donor radius has nearly eliminated the risk of pathologic radial bone fractures. Limited long-term donor and recipient site complications support the use of this flap for single-stage mandibular reconstruction.
    MeSH term(s) Adult ; Aged ; Aged, 80 and over ; Bone Plates ; Female ; Forearm ; Graft Survival ; Humans ; Hypesthesia/etiology ; Male ; Mandible/surgery ; Mandibular Injuries/surgery ; Mandibular Neoplasms/surgery ; Middle Aged ; Muscle Weakness/etiology ; Postoperative Complications ; Radius/transplantation ; Radius Fractures/etiology ; Regression Analysis ; Retrospective Studies ; Surgical Flaps ; Transplant Donor Site ; Young Adult
    Language English
    Publishing date 2013-02
    Publishing country United States
    Document type Journal Article
    ZDB-ID 2701825-8
    ISSN 2168-619X ; 2168-6181
    ISSN (online) 2168-619X
    ISSN 2168-6181
    DOI 10.1001/jamaoto.2013.1615
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  8. Article ; Online: Impact of Primary Tracheoesophageal Puncture on Outcomes after Total Laryngectomy.

    Panwar, Aru / Militsakh, Oleg / Lindau, Robert / Coughlin, Andrew / Sayles, Harlan / Rieke, Katherine R / Lydiatt, William / Lydiatt, Daniel / Smith, Russell

    Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery

    2017  Volume 158, Issue 1, Page(s) 103–109

    Abstract: ... Patients who underwent a TEP at the time of laryngectomy (n = 68) were compared with patients who underwent ... laryngectomy without a TEP (n = 362). Postoperative wound complications and secondary outcomes, including ...

    Abstract Objectives To identify differences in postoperative wound complications associated with a primary tracheoesophageal puncture (TEP) at the time of laryngectomy versus no TEP. Study Design Retrospective review of large national data set. Setting Academic and nonacademic health care facilities in United States, contributing de-identified, risk-adjusted clinical data to the American College of Surgeons National Surgical Quality Improvement Program. Subjects and Methods The National Surgical Quality Improvement Program data set for years 2006 to 2012 identified 430 patients who underwent total laryngectomy with or without a primary TEP. Patients who underwent a TEP at the time of laryngectomy (n = 68) were compared with patients who underwent laryngectomy without a TEP (n = 362). Postoperative wound complications and secondary outcomes, including medical complications and length of hospitalization, were compared between the groups. Results The incidence of "superficial" and "deep or organ space" surgical site infection, medical complications, return to the operating room, and length of hospitalization were similar between the groups. Patients in the TEP group had a higher overall wound complication rate (relative risk, 2.02; 95% CI = 1.06-3.84; attributable risk, 8.17%; number needed to harm, 12). Conclusions Performance of a primary TEP concurrent to total laryngectomy contributed to a small increase in attributable risk for overall wound complications but did not add substantial risk for "superficial" or "deep or organ space" surgical site infection, medical complications, or increased burden for resource utilization. These data may help inform patient choice and physician recommendations for primary alaryngeal speech rehabilitation.
    MeSH term(s) Aged ; Female ; Humans ; Laryngectomy/methods ; Length of Stay/statistics & numerical data ; Male ; Middle Aged ; Outcome and Process Assessment (Health Care) ; Patient Safety ; Postoperative Complications/epidemiology ; Punctures ; Quality Improvement ; Reoperation/statistics & numerical data ; Retrospective Studies ; Risk Assessment ; Speech, Alaryngeal ; Trachea/surgery ; United States/epidemiology
    Language English
    Publishing date 2017-08-15
    Publishing country England
    Document type Journal Article
    ZDB-ID 392085-9
    ISSN 1097-6817 ; 0161-6439 ; 0194-5998
    ISSN (online) 1097-6817
    ISSN 0161-6439 ; 0194-5998
    DOI 10.1177/0194599817722938
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  9. Article ; Online: Impact of pharyngeal closure technique on fistula after salvage laryngectomy.

    Patel, Urjeet A / Moore, Brian A / Wax, Mark / Rosenthal, Eben / Sweeny, Larissa / Militsakh, Oleg N / Califano, Joseph A / Lin, Alice C / Hasney, Christian P / Butcher, R Brent / Flohr, Jamie / Arnaoutakis, Demetri / Huddle, Matthew / Richmon, Jeremy D

    JAMA otolaryngology-- head & neck surgery

    2013  Volume 139, Issue 11, Page(s) 1156–1162

    Abstract: ... technique: primary closure (n = 99), pectoralis onlay flap (n = 40), and interposed free tissue (n = 220 ...

    Abstract Importance: No consensus exists as to the best technique, or techniques, to optimize wound healing, decrease pharyngocutaneous fistula formation, and shorten both hospital length of stay and time to initiation of oral intake after salvage laryngectomy. We sought to combine the recent experience of multiple high-volume institutions, with different reconstructive preferences, in the management of pharyngeal closure technique for post-radiation therapy salvage total laryngectomy in an effort to bring clarity to this clinical challenge.
    Objective: To determine if the use of vascularized flaps in either an onlay or interposed fashion reduces the incidence or duration of pharyngocutaneous fistula after salvage laryngectomy compared with simple primary closure of the pharynx.
    Design: Multi-institutional retrospective review of all patients undergoing total laryngectomy after having received definitive radiation therapy with or without chemotherapy between January 2005 and January 2012, conducted at 7 academic medical centers.
    Setting: Academic, tertiary referral centers.
    Patients: The study population comprised 359 patients from 8 institutions. All patients had a history of laryngeal irradiation and underwent laryngectomy between 2005 and 2012. They were grouped as primary closure, pectoralis myofascial onlay flap, or interposed free tissue. All patients had a minimum of 4 months follow-up.
    Main outcomes and measures: Fistula incidence, severity, and predictors of fistula.
    Results: Of the 359 patients, fistula occurred in 94 (27%). For patients with fistula, hospital stay increased from 8.9 to 12.1 days (P < .001) and oral diet initiation was delayed from 10.5 days to 29.9 days (P < .001). Patients were grouped according to closure technique: primary closure (n = 99), pectoralis onlay flap (n = 40), and interposed free tissue (n = 220). Incidence of fistula with primary closure was 34%. For the interposed free flap group, the fistula rate was lower at 25% (P = .07). Incidence of fistula was the lowest for the pectoralis onlay group at 15% (P = .02). Multivariate analysis confirmed a significantly lower fistula rate with either flap technique. For patients who developed fistula, mean duration of fistula was significantly prolonged with primary closure (14.0 weeks) compared with pectoralis flap (9.0 weeks) and free flap (6.5 weeks).
    Conclusions and relevance: Pharyngocutaneous fistula remains a significant problem following salvage laryngectomy. Use of nonirradiated, vascularized flaps reduced the incidence and duration of fistula and should be considered during salvage laryngectomy.
    MeSH term(s) Carcinoma, Squamous Cell/surgery ; Cutaneous Fistula/etiology ; Cutaneous Fistula/surgery ; Female ; Fistula/etiology ; Fistula/surgery ; Follow-Up Studies ; Humans ; Laryngeal Neoplasms/surgery ; Laryngectomy/methods ; Male ; Middle Aged ; Pharyngeal Diseases/etiology ; Pharyngeal Diseases/urine ; Pharynx/surgery ; Postoperative Complications ; Reconstructive Surgical Procedures/methods ; Retrospective Studies ; Salvage Therapy ; Surgical Flaps ; Treatment Outcome
    Language English
    Publishing date 2013-11
    Publishing country United States
    Document type Comparative Study ; Journal Article ; Multicenter Study
    ZDB-ID 2701825-8
    ISSN 2168-619X ; 2168-6181
    ISSN (online) 2168-619X
    ISSN 2168-6181
    DOI 10.1001/jamaoto.2013.2761
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  10. Article: The role of the osteocutaneous radial forearm free flap in the treatment of mandibular osteoradionecrosis.

    Militsakh, Oleg N / Wallace, Derrick I / Kriet, J David / Tsue, Terance T / Girod, Douglas A

    Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery

    2005  Volume 133, Issue 1, Page(s) 80–83

    Abstract: Objective: To evaluate the role of the osteocutaneous radial forearm free flap (OCRFFF) in the treatment of mandibular osteoradionecrosis (ORN).: Study design and setting: Retrospective case review of patients who underwent OCRFFF oromandibular ... ...

    Abstract Objective: To evaluate the role of the osteocutaneous radial forearm free flap (OCRFFF) in the treatment of mandibular osteoradionecrosis (ORN).
    Study design and setting: Retrospective case review of patients who underwent OCRFFF oromandibular reconstruction after resection of nonviable tissue at an academic tertiary care center because of ORN. Patients with reconstructions other than OCRFFF were excluded from this study.
    Results: Nine patients underwent a composite oromandibular resection for ORN with a reconstruction using an OCRFFF between April 1998 and February 2003. All patients had failed previous less aggressive surgical and medical management of the ORN. Mean follow-up was 36 months (range, 14-67 months). There were no flap failures or significant immediate postoperative or long-term complications observed. All patients had successful restoration of mandibular integrity and continuity, with 100% success rate of stabilization of ORN. All patients were able to tolerate PO diet, with only one third having to supplement their diet with gastrostomy feedings, compared with 89% gastrostomy dependence preoperatively.
    Conclusions: Primary or adjuvant radiotherapy for head and neck malignancies can result in ORN of the mandible. This difficult problem often requires surgical intervention. In our experience, the OCRFFF can be successfully used for oromandibular reconstruction, even in the setting of the heavily radiated tissue with excellent postoperative outcomes.
    Significance: This is the first study that demonstrates the efficacy of the OCRFFF as a treatment of mandibular ORN.
    MeSH term(s) Aged ; Carcinoma, Squamous Cell/radiotherapy ; Female ; Forearm/surgery ; Graft Survival ; Head and Neck Neoplasms/radiotherapy ; Humans ; Male ; Mandibular Diseases/etiology ; Mandibular Diseases/surgery ; Melanoma/radiotherapy ; Middle Aged ; Osteoradionecrosis/etiology ; Osteoradionecrosis/surgery ; Radiotherapy/adverse effects ; Radius/transplantation ; Retrospective Studies ; Surgical Flaps ; Treatment Outcome
    Language English
    Publishing date 2005-07
    Publishing country England
    Document type Journal Article
    ZDB-ID 392085-9
    ISSN 1097-6817 ; 0194-5998 ; 0161-6439
    ISSN (online) 1097-6817
    ISSN 0194-5998 ; 0161-6439
    DOI 10.1016/j.otohns.2005.03.018
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