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Coronoid-Temporalis Pedicled Flap for Orbital Floor Defect Reconstruction

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Flap Complications Following Maxillectomy, Reconstructive Surgery, and Postoperative Proton Radiotherapy: A Cohort

Amir H Safavi^1,2, Fan Yang³, Yingzhi Wu¹

¹Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York, USA.

|September 8, 2025

Summary

Flap complications after maxillectomy, reconstruction, and proton beam therapy (PBT) are not well documented. Higher radiation doses to the flap increased the risk of necrosis and fistulization, suggesting careful planning is needed.

Keywords:

flap complications flap reconstruction proton beam therapy sinonasal cancer

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Area of Science:

Oncology
Radiation Oncology
Head and Neck Surgery

Background:

Flap complications after maxillectomy, reconstruction, and adjuvant proton beam therapy (PBT) for maxillary and sinonasal malignancies are not well described.
Understanding these complications is crucial for optimizing treatment outcomes.

Purpose of the Study:

To investigate the incidence and risk factors of flap complications following maxillectomy, reconstruction, and adjuvant PBT.
To identify specific radiation dose parameters associated with flap complications.

Main Methods:

Retrospective cohort study of patients treated between 2016 and 2023.
Analysis of patient data including surgical details, PBT parameters, and postoperative outcomes.
Correlation of flap dose metrics with complication development.

Main Results:

Three out of thirteen patients (23.1%) experienced flap necrosis or fistulization after PBT, with a median onset of 112 days post-therapy.
Higher mean and minimum flap doses, and higher doses to specific flap volumes, were significantly associated with complications.
No immediate postoperative complications were observed.

Conclusions:

Adjuvant PBT for high-risk maxillary and sinonasal malignancies can lead to flap complications.
Careful patient selection and precise treatment planning are essential to minimize flap complication risks.
Radiation dose parameters to the flap should be carefully considered during treatment planning.