Impact of Specialty Training on the Association between Flap Size and Incidence of Complications following Microvascular Head and Neck Reconstruction for Cancer.

[BACKGROUND] The scope of otolaryngology and plastic surgery overlap within head and neck reconstruction is increasing; yet comparative outcome studies between these two subspecialties are limited.

[METHODS] A retrospective review was performed on all patients who underwent microvascular reconstruction of a postablative head and neck defect at a quaternary academic medical center between January 2000 and October 2011. Postoperative outcomes were reviewed by subspecialty and Mann-Whitney analysis was used to investigate any flap size differences between cohorts with and without complications.

[RESULTS] A consecutive series of 129 (66.8%) otolaryngology cases and 64 (33.2%) plastic surgery cases comprised the entire study sample. Plastic surgery flaps were significantly larger than otolaryngology flaps (9.7 vs. 8.5 cm, p = 0.004). Flap complication rates (31.8 vs. 37.5%, p = 0.429) and flap failure rates (5.4 vs. 4.7%, p = 0.429) were comparable between subspecialties. However, a significant difference in flap size was evident between the cohorts with and without flap complications following microvascular reconstruction by otolaryngology (9.18 vs. 8.15 cm, p = 0.042). This difference was not detected following reconstruction by plastic surgery (9.34 vs. 9.04 cm, p = 0.225). For the overall sample, there was a correlation between increasing flap size and higher tumor stages (significant at T4, p = 0.003) as well as advanced T-stage and medical complications (p = 0.004).

[CONCLUSION] Plastic surgeons should maintain an active role in the reconstruction of complex, microvascular head and neck cases such as those that require larger flaps and/or of advanced T-stages.