Impact of smoking on donor site following rectus flap harvest for head and neck reconstruction

Mac Kenzie Reece; Tyler L Langenfeld; Kaitlynne Y Pak; Mark K Wax; Kenneth Tan; Allison Slijepcevic; Dan Petrisor; Mohamedkazim Alwani; R Michael Johnson; Yadranko Ducic; Sameep P Kadakia

doi:10.1016/j.amjoto.2023.103847

Impact of smoking on donor site following rectus flap harvest for head and neck reconstruction

Am J Otolaryngol. 2023 Jul-Aug;44(4):103847. doi: 10.1016/j.amjoto.2023.103847. Epub 2023 Mar 20.

Authors

Affiliations

¹ Wright State University Boonshoft School of Medicine, Department of Surgery, Dayton, OH, United States of America. Electronic address: mjreece@premierhealth.com.
² Wright State University Boonshoft School of Medicine, Dayton, OH, United States of America. Electronic address: langenfeld.3@wright.edu.
³ Cedars Sinai Medical Center, Division of Otolaryngology-Head and Neck Surgery, Los Angeles, CA, United States of America.
⁴ Department of Otolaryngology-Head and Neck Surgery, Oregon Health Science University, Portland, OR, United States of America. Electronic address: waxm@ohsu.edu.
⁵ Department of Otolaryngology-Head and Neck Surgery, Oregon Health Science University, Portland, OR, United States of America. Electronic address: tanken@ohsu.edu.
⁶ Department of Otolaryngology-Head and Neck Surgery, Wake Forest University, Winston Salem, NC, United States of America. Electronic address: slijepce@ohsu.edu.
⁷ Department of Oral Maxillo Facial Surgery, Oregon Health Science University, Portland, OR, United States of America. Electronic address: petrisor@ohsu.edu.
⁸ Department of Plastic and Reconstructive Surgery, Wright State University Boonshoft School of Medicine, United States of America.
⁹ Otolarygology and Facial Plastic Surgery Assoc., Forth Worth, TX, United States of America.
¹⁰ Department of Plastic and Reconstructive Surgery, Wright State University Boonshoft School of Medicine, 30 E Apple St, Suite 2200, 45409, Dayton, OH, United States of America. Electronic address: Sameep8779@gmail.com.

PMID: 36989752
DOI: 10.1016/j.amjoto.2023.103847

Abstract

Objectives: The rectus abdominis myocutaneous free flap has been widely used as a reconstructive option in head and neck reconstruction with great success. Challenging the popular assumption, this study sought to examine the effects of smoking on donor site complications in this population.

Methods: Multi-institution retrospective study of 103 patients (50 active smokers, 28 former and 25 never smoked).

Results: Overall complication rate was 14.5 %. Hernia rate 4.8 %, evisceration 0 %, dehiscence 2.9 %, infection 6.7 %. Smoking history did not significantlly influence complication rates (chi square test, p = 0.33). Abdominal wall closure technique also did not influence the complication rate (chi square test, p = 0.58).

Conclusions: The rectus abdomonis myocutaneous free flap has an acceptable complication rate that does not appear to be influenced by smoking history. While patients should be counseled regarding smoking cessation, smoking habits should not delay treatment nor obviate consideration of rectus flap utilization.

Keywords: Head and neck; Microvascular reconstruction; Wound healing.

MeSH terms

Head
Humans
Myocutaneous Flap*
Neck
Postoperative Complications / epidemiology
Postoperative Complications / etiology
Retrospective Studies
Smoking* / adverse effects