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CC BY-NC-ND 4.0 · J Reconstr Microsurg Open 2024; 09(01): e69-e71
DOI: 10.1055/a-2287-6606
Original Article

Trends of Microsurgical Head and Neck Free Flap Reconstruction and Safety during the COVID-19 Pandemic

Valeria P. Bustos
1   Division of Plastic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
,
Nicholas Elmer
1   Division of Plastic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
,
Anamika Veeramani
1   Division of Plastic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
,
Carly D. Comer
1   Division of Plastic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
,
JacqueLyn R. Kinney
1   Division of Plastic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
,
Samuel M. Manstein
1   Division of Plastic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
,
Natalie Hassell
1   Division of Plastic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
,
Bernard T. Lee
1   Division of Plastic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
,
Samuel J. Lin
1   Division of Plastic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
2   Division of Otolaryngology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
› Author Affiliations Funding S.J.L. has Royalties from McGraw-Hill Publishing. The rest of the authors do not have a financial interest in any of the information mentioned in this manuscript.
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Abstract

Background The coronavirus disease 2019 (COVID-19) pandemic poses unprecedented challenges among patients with head and neck (HN) cancer that require oncological and reconstructive surgeries. This study aims to identify differences in postoperative outcomes for patients who underwent microsurgical HN free flap reconstruction prior to versus during the COVID-19 pandemic.

Methods A retrospective observational study using the American College of Surgeons National Surgical Quality Improvement Program 2019 to 2020 database to identify patients with HN cancer who underwent a vascularized free tissue transfer was undertaken. Two cohorts were created: pre- and during COVID-19. Fisher's exact test and the unpaired Student's t-test were used to evaluate differences in sociodemographic and clinical characteristics between the cohorts. Multivariable logistic regression was used to assess differences in reoperation rates between groups as well as to identify potential risk factors for reoperation.

Results A total of 763 patients were analyzed. The mean age of patients in the overall cohort was 63.6 (standard deviation: 11.5) years. Most patients were white (62.7%). Overall, no statistically significant difference was evidenced between cohorts in terms of immediate postoperative outcomes. Similarly, reoperation rates were similar between groups (p > 0.05). Dependent functional status (p = 0.021) and postoperative infection (p < 0.001) were found to be risk factors for reoperation after holding other factors constant.

Conclusion HN flap reconstruction can be performed safely during the COVID-19 era. Standardized protocols for patient selection must be strictly followed to avoid disease progression and optimize surgical outcomes. Further studies assessing long-term outcomes during the pandemic are of utmost importance to elucidate the true impact of the COVID-19 pandemic on this population.

Keywords

reconstruction - microsurgery - head and neck - COVID-19

Ethical Approval

The authors are accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. This study was IRB approved (#2021D001052) at the Beth Israel Deaconess Medical Center.


Author Contributions

Conception and design are made by V.P.B., N.E., B.T.L., S.J.L.; administrative support was given by B.T.L., S.J.L.; collection and assembly of data was done by V.P.B., N.E.; data analysis and interpretation were done by V.P.B., N.E., S.J.L.;V.P.B., N.E., A.V. did the manuscript writing; final approval of manuscript was made by V.P.B., N.E., A.V., C.D.C., J.R.K., S.M.M., N.H., B.T.L., S.J.L.


Supplementary Material



Publication History

Received: 24 November 2023

Accepted: 16 February 2024

Accepted Manuscript online:
14 March 2024

Article published online:
26 April 2024

© 2024. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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