Quality of life after Lower-Face Reconstruction with free or Pedicled Flaps

Abstract

Abstract: DEGREE PROJECT, PROGRAMME IN MEDICINE Quality of life after lower-face reconstruction with free or pedicled flaps Author: Victoria Strålman, 2016 Supervisor: Mattias Lidén, Andri Thórarinsson and Victoria Fröjd Dept. of Plastic Surgery, Sahlgrenska University Hospital, University of Gothenburg, Sweden Background: Lower face reconstruction is major surgery and requires considerable resources and risk for complications. Therefore, the importance of a successful outcome and acceptable health-related quality of life (HR-QoL) after the reconstruction is essential. At the Sahlgrenska University Hospital in Gothenburg, mainly three types of flaps are used: a free fibula flap (FFF), a free radial forearm flap (FRF) and a pectoralis myocutaneous flap (PMF). Objectives: The aim was to present and compare preoperative patient related factors and postoperative HR-QoL between groups having received reconstruction with a free flap (FF) or reconstruction with a PMF. Methods: A retrospective study was conducted of patients reconstructed in the lower face using free or pedicled flap, during the period 2000 – 2014. Data on preoperative, intraoperative and postoperative parameters were collected from the patients medical records. Additionally, three well-validated questionnaires, IOQL SF36, EORTC QLQ-C30 and EORTC QLQ-H&N35, were dispatched to all still-living patients in the two study groups (FF and PMF) for evaluation of HR-QoL. The patient related parameters and questionnaire responses were compared between the two groups. Results: There were significant differences between the groups regarding several patient-related factors, (age, comorbidity, time of surgery, mortality and a number of HR-QoL scales and items). Five- and ten-year survival rates for the FFF and FRF groups were 62 ± 6% and 47 ± 8% respectively, and for the PMF group 39 ± 10% at both time-points. Conclusion: Patients reconstructed with a PMF are generally older and have more comorbidities compared to patients reconstructed with FF. Patients reconstructed with FF generally had a HR-QoL comparable with reference materials, while patients with PMF had poorer HR-QoL compared to both the reference materials and patients reconstructed with FF. The results show that the main complaints concern swallowing and decreased ability of opening mouth. Keywords: Head and neck neoplasms, surgical flaps, free microvascular flaps, mandibular reconstruction, health-related quality of life, osteoradionecrosis