Author(s)
Adam Hatala, BS
Ade Obayemi, MD
Mallory Rowley, BS
Ethan Fung, BS
Neal Deot, MD.
Affiliation(s)
SUNY Upstate Medical School;
Abstract:
Educational Objective: At the conclusion of this presentation, the participants should be able to understand that Integra has long term durability following the effects of radiotherapy.
Objectives: Prior studies have suggested possible adverse effects of prior radiotherapy on likelihood of graft take, citing as low as 50% in some reports. Although there are preliminary studies suggesting the long term durability of Integra placement prior to adjuvant radiotherapy, there are limited studies thoroughly describing the complication profile in this unique group of patients -- including hematoma/seroma collection, infection, poor graft take, contour irregularities, premature silicone separation, and color mismatch after skin grafting. The goal of this consecutive case series will be to examine the percent graft take and secondary complication rates amongst patients receiving Integra for scalp and forehead reconstruction prior to adjuvant radiotherapy over a 10 year period from a tertiary medical center. A systematic review will be conducted to further elucidate the utility of Integra prior to radiotherapy and to determine wound complication rates across the current literature.
Study Design: Retrospective series and systematic review.
Methods: Inclusion criteria include both male/female patients of any age requiring head and neck reconstruction for full thickness soft tissue defects followed by radiotherapy treated with Integra skin substitute. Exclusion criteria include reconstruction site other than scalp/forehead, animal studies, studies with insufficient information to extract data, partial thickness defects, or patients who did not receive adjuvant radiotherapy. The retrospective case series will be performed utilizing clinical data available at a tertiary urban medical center.
Results: 46 patient charts were reviewed for patients who received Integra based forehead/scalp reconstruction for ablative oncologic defects between 2012-2022. The average age was 71 + 14 years, 36/46 patients were male, and 40/46 patients identified as white. The average defect size was 29.3 + 25.8 cm2 and the most common reconstructive site was scalp (n=20) followed by forehead (n=5). 5/46 patients developed incomplete graft take er primary reconstruction; 3/5 of these patients had received prior radiotherapy. There were a total of 5/46 (11%) of patients who received adjuvant radiation. 2/5 patients who received adjuvant radiation developed seromas within the first postoperative visit. There were no incidences of incomplete graft take either prior to or during radiotherapy for any patient who received adjuvant treatment. Further national data is pending and will be completed before submission.
Conclusions: Although prior radiotherapy may be a predictor of unsuccessful Integra graft take, there was no incidence of incomplete graft take among patients before or after adjuvant radiotherapy. Secondary complications such as hematoma, seroma, infection, and contour mismatch were also comparable between radiotherapy and non-radiotherapy patients in this series. Further national data will be analyzed and compared with this preliminary conclusion.