Gluteal artery perforator flap: a viable alternative for sacral radiation ulcer and osteoradionecrosis

Cheon, Young Woo; Lee, Myung Chul; Kim, Young Seok; Rah, Dong Kyun; Lee, Won Jai

doi:10.1016/j.bjps.2009.01.081

Cited by 26 publications

(43 citation statements)

References 14 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…11 Noteworthy, endothelial cell injury can, within this context, potentially affect both conduit vessels and the microcirculation with a variety of different complications. 12 The latter can, in fact, lead to impaired integration of the flap into the flap bed, that is, inosculation, 13 which in its worst form could eventually lead to a “floating flap.” 14 Decreased vascularization of the graft bed has been demonstrated histologically after preoperative radiotherapy. 15 However, the pathology is not limited to endothelial cell injury only but rather a consequence of general cellular dysfunction of the irradiated bed.…”

Section: Discussionmentioning

confidence: 99%

Improved Head and Neck Free Flap Outcome—Effects of a Treatment Protocol Adjustment from Pre- to Postoperative Radiotherapy

Halle

Eriksson

Skogh

et al. 2017

Plastic and Reconstructive Surgery - Global Open

View full text Add to dashboard Cite

Background:The impact of preoperative radiotherapy on microvascular reconstructive surgery outcome has been a subject of debate. However, data are conflicting and often dependent on local treatment protocols. We have studied the effects of radiotherapy in a unique, single-center setting where a treatment protocol change was undertaken from pre- to postoperative radiotherapy administration for microsurgical head and neck reconstructions.Methods:A cohort study was conducted for 200 consecutive head and neck free flap cases, where 100 were operated on before and 100 after the treatment protocol adjustment in 2006. Only direct cancer reconstructions were included. Complication rates of anastomosis-related (flap necrosis) and flap bed–related (infection, fistula, and wound dehiscence) complications were compared between irradiated and nonirradiated patients. A multivariate analysis was performed to correct for treatment period.Results:One hundred twenty-six patients had received radiotherapy before reconstruction due to cases of cancer recurrence. There were no significant differences in demographic data or risk factors between irradiated and nonirradiated cases. Irradiated cases had a higher rate of both flap loss (9.5% versus 1.4%; P = 0.034) and flap bed–related complications (29% versus 13%; P = 0.014). However, after multivariate analysis, there was only a significant relationship between preoperative irradiation and infection (odds ratio = 2.51; P = 0.033) and fistula formation (odds ratio = 3.13; P = 0.034).Conclusions:The current single-center study clearly indicates that preoperative radiotherapy is a risk factor for both infection and fistula formation, most likely related to an impaired flap bed. We suggest postoperative radiotherapy administration whenever possible for oncological reasons, otherwise proper antibiotic cover and meticulous flap insetting to prevent radiation-related infection and fistula formation.

show abstract

Section: Discussionmentioning

confidence: 99%

Improved Head and Neck Free Flap Outcome—Effects of a Treatment Protocol Adjustment from Pre- to Postoperative Radiotherapy

Halle

Eriksson

Skogh

et al. 2017

Plastic and Reconstructive Surgery - Global Open

View full text Add to dashboard Cite

show abstract

“…ORN is also seen in the maxilla and described in the sacrum (36,37). The cumulative incidence of mandibular ORN in adults with head and neck cancer ranges from 3 - 8% (38-40).…”

Section: Specific Examples Of Late Effectsmentioning

confidence: 99%

Radiation-Related Treatment Effects Across the Age Spectrum: Differences and Similarities or What the Old and Young Can Learn from Each Other

Krasin

Constine

Friedman³

et al. 2010

Seminars in Radiation Oncology

View full text Add to dashboard Cite

Radiation related effects in children and adults limit the delivery of effective radiation doses and result in long-term morbidity affecting function and quality of life. Improvements in our understanding of the etiology and biology of these effects, including the influence of clinical variables, dosimetric factors, and the underlying biologic processes has made treatment safer and more efficacious. However, the approach to studying and understanding these effects differs between children and adults. By using the pulmonary and skeletal organ systems as examples, comparisons are made across the age spectrum for radiation related effects including pneumonitis, pulmonary fibrosis, osteonecrosis and fracture. Methods for dosimetric analysis, incorporation of imaging and biology as well a length of follow-up are compared, contrasted and discussed for both organ systems in children and adults. Better understanding of each age specific approach and how it differs may improve our ability to study late effects of radiation across the ages

show abstract

“…44 Compared to these flaps, gluteal artery perforator flaps are able to preserve intact muscle with minimal donor-site morbidity and are widely used for the reconstruction of sacral pressure ulcers. 45 These well-vascularized fasciocutaneous flaps are also sufficient to control infection in the sacral area. Cheon et al presented favorable clinical results whereby 10 patients with chronic non-healing sacral radiation ulcers were successfully treated with gluteal artery perforator flaps.…”

Section: -24mentioning

confidence: 99%

“…Cheon et al presented favorable clinical results whereby 10 patients with chronic non-healing sacral radiation ulcers were successfully treated with gluteal artery perforator flaps. 45 When an appropriate perforator is recognized pre-operatively, this perforator flap may be a valuable alternative for treating sacral radiation ulcers.…”

Section: -24mentioning

confidence: 99%

See 1 more Smart Citation

Surgical Reconstruction of Radiation Injuries

Fujioka

2014

Advances in Wound Care

View full text Add to dashboard Cite

Gluteal artery perforator flap: a viable alternative for sacral radiation ulcer and osteoradionecrosis

Cited by 26 publications

References 14 publications

Improved Head and Neck Free Flap Outcome—Effects of a Treatment Protocol Adjustment from Pre- to Postoperative Radiotherapy

Improved Head and Neck Free Flap Outcome—Effects of a Treatment Protocol Adjustment from Pre- to Postoperative Radiotherapy

Radiation-Related Treatment Effects Across the Age Spectrum: Differences and Similarities or What the Old and Young Can Learn from Each Other

Surgical Reconstruction of Radiation Injuries

Contact Info

Product

Resources

About