Microvascular Free Flap Outcomes in Maxillectomy Defects from Invasive Fungal Sinusitis

Shilpa M. Rao, Department of Otolaryngology - Head and Neck Surgery, University of Alabama at Birmingham, Birmingham, Alabama, USA.
P Daniel Knott, Department of Otolaryngology - Head and Neck Surgery, University of California San Francisco Medical Center, San Francisco, California, USA.
Larissa Sweeny, Department of Otolaryngology - Head and Neck Surgery, University of Miami, Miami, Florida, USA.
Aaron Domack, Department of Otolaryngology - Head and Neck Surgery, University of Cincinnati, Cincinnati, Ohio, USA.
Alice Tang, Department of Otolaryngology - Head and Neck Surgery, University of Cincinnati, Cincinnati, Ohio, USA.
Rusha Patel, Department of Otolaryngology - Head and Neck Surgery, Oklahoma University Health Science Center, Oklahoma City, Oklahoma, USA.
Amy L. Pittman, Department of Otolaryngology - Head and Neck Surgery, Loyola University Medical Center, Chicago, Illinois, USA.
J Reed Gardner, Department of Otolaryngology - Head and Neck Surgery, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA.
Mauricio A. Moreno, Department of Otolaryngology - Head and Neck Surgery, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA.
Jumin Sunde, Department of Otolaryngology - Head and Neck Surgery, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA.
Taylor B. Cave, Department of Otolaryngology - Head and Neck Surgery, Mayo Clinic Arizona, Scottsdale, Arizona, USA.
Nicolaus D. Knight, Department of Otolaryngology - Head and Neck Surgery, University of Alabama at Birmingham, Birmingham, Alabama, USA.
Ben Greene, Department of Otolaryngology - Head and Neck Surgery, University of Alabama at Birmingham, Birmingham, Alabama, USA.
Patrik Pipkorn, Department of Otolaryngology - Head and Neck Surgery, Washington University, St. Louis, Missouri, USA.
Arjun S. Joshi, Division of Otolaryngology - Head and Neck Surgery, The George Washington University, Washington, DC, USA.
Punam Thakkar, Division of Otolaryngology - Head and Neck Surgery, The George Washington University, Washington, DC, USA.
Keven Ji, Department of Otolaryngology - Head and Neck Surgery, Oregon Health and Science University School of Medicine, Portland, Oregon, USA.
Sara Yang, Department of Otolaryngology - Head and Neck Surgery, Oregon Health and Science University School of Medicine, Portland, Oregon, USA.
Brent A. Chang, Department of Otolaryngology - Head and Neck Surgery, Mayo Clinic Arizona, Scottsdale, Arizona, USA.
Mark K. Wax, Department of Otolaryngology - Head and Neck Surgery, Oregon Health and Science University School of Medicine, Portland, Oregon, USA.
Carissa M. Thomas, Department of Otolaryngology - Head and Neck Surgery, University of Alabama at Birmingham, Birmingham, Alabama, USA.

Document Type

Journal Article

Publication Date

9-29-2023

Journal

The Laryngoscope

DOI

10.1002/lary.31081

Keywords

free flap; head and neck reconstruction; invasive fungal sinusitis; mucormycosis; outcomes

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: IV Laryngoscope, 2023.

Department

Surgery

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