Appearance‐Related Distress and Social Functioning after Head and Neck Microvascular Reconstruction

Abstract

Objectives/Hypothesis To better understand aesthetic patient‐reported outcomes and psychosocial quality of life (QOL) after head and neck microvascular reconstruction for benign or malignant tumors. Study Design Single‐center prospectively obtained in‐office validated questionnaire‐based study. Methods Analysis of prospectively collected surveys at a tertiary care academic center from June 2018 to February 2021. Patients completed two FACE‐Q scales: Appearance‐Related Psychosocial Distress (ARPD) and Social Function (SF). Survey scores, demographics, operative course, and adjuvant therapy data underwent univariate and multivariable analyses. Results One hundred and three patients completed surveys at a median of 13.5 months postoperatively (interquartile range: 5.2–30.8). Mean ARPD from 0 (no distress) to 100 (maximum distress) was 32.4 (standard error of the mean [SEM]: 2.7). Mean SF from 0 (worst functioning) to 100 (best functioning) was 55.5 (SEM: 2.7). Postoperative adjuvant radiation was associated with 13.9% higher ARPD (95% CI: 3.4–24.4, P = .019) and 10.4% lower SF (95% CI: −20.7 to −0.1, P = .047). Each appearance‐related question on the ARPD scale independently predicted impaired SF (P < .001 for all questions). Upon multivariable logistic regression, osteocutaneous reconstruction, compared to soft tissue alone (P = .043), and postoperative adjuvant radiation (P = .014) were associated with higher levels of ARPD. Age, sex, relationship status, anxiety or depression history, defect location, and hospital stay were not significantly associated with ARPD or SF scores. Conclusions Aesthetic outcomes are important determinants of psychosocial QOL following head and neck microvascular reconstruction: an effect that is worsened by adjuvant radiation. Reconstructive surgeons should prioritize aesthetic outcomes, in addition to functional restoration, to optimize social functioning in patients with head and neck tumors. Level of Evidence 3 Laryngoscope, 131:E2204–E2211, 2021

Patient-Reported Aesthetic and Psychosocial Outcomes After Microvascular Reconstruction for Head and Neck Cancer

“…Psychosocial function after head and neck reconstruction is associated with patient-perceived aesthetic outcomes . This study reports the risk of poor long-term aesthetic outcomes among patients with HNC who undergo MFTT.…”

“…These procedures may be used to address facial ptosis and skin asymmetry or redundancy. As reported previously, adjuvant radiotherapy is associated with worse aesthetic outcomes, in part due to significant scarring and lymphedema. Submental or cervical liposuction, fat augmentation, and flap refinement are potential methods for counteracting these posttreatment changes .…”

“…A recent questionnaire-based study has reported that osteocutaneous reconstruction and adjuvant radiotherapy are associated with an increase in the risk of poor aesthetic outcomes within 1 year from MFTT, but there is a paucity of literature describing long-term outcomes, specifically among patients with malignant disease. As technological advances continue to improve the survival for patients with advanced cancer, it is necessary to understand long-term treatment ramifications on aesthetic outcomes.…”

Factors Associated With Risk of Body Image–Related Distress in Patients With Head and Neck Cancer

“…Further complicating this association is that free flaps are a heterogenous group that consists of different types of flaps (eg, osseous or nonosseous), tissue characteristics, donor sites, and other characteristics that vary widely. For example, some studies have found that patients undergoing osseous free flap reconstruction are at higher risk for BID compared with those undergoing a nonosseous reconstruction, although other studies, including the current one, have not. This discrepancy could be explained by a number of factors, including small sample size or differences in measures of BID.…”

Health-Related Quality of Life, Psychosocial Distress and Unmet Needs in Older Patients With Head and Neck Cancer

“…Body image studies in HNC have mostly been undertaken in samples of patients undergoing major surgery for their cancer, as detailed in Table 10 . In summary, evidence of an association between age and body image distress is weak but limited cross-sectional and retrospective data suggest similar or less severe body image distress in older HNC patients ( 172 – 175 ). Further high-quality research is needed in this area.…”