2341 - Repair Type and Risk of Wound Healing Complications after Surgery and Adjuvant Radiotherapy for Non-Melanoma Skin Cancer
Presenter(s)
K. Shahwan1, M. Viveiros1, M. Gallardo1, V. Yildiz2, L. Voller1, T. Walker1, D. J. DiCostanzo3, S. Baliga4, D. M. Blakaj3, C. T. Haring5, D. J. Konieczkowski3, and D. Carr1; 1Department of Dermatology, The Ohio State University Medical Center, Columbus, OH, 2Center for Biostatistics, The Ohio State University Medical Center, Columbus, OH, 3Department of Radiation Oncology, James Cancer Hospital/Wexner Medical Center, The Ohio State University, Columbus, OH, 4Department of Radiation Oncology, James Cancer Hospital, The Ohio State University Medical Center, Columbus, OH, 5The Ohio State University Department of Otolaryngology - Head & Neck Surgery, Columbus, OH
Purpose/Objective(s): Adjuvant radiotherapy (RT) reduces the risk of locoregional recurrence in completely resected Brigham and Women’s Hospital (BWH) stage T2b and T3 cutaneous squamous cell carcinomas (cSCCs) by approximately 55%. Although free flap reconstruction is commonly used in other contexts requiring both surgery and radiotherapy, the influence of specific reconstructive techniques on risk of post-RT wound complications for cSCC has not been well studied.
Materials/Methods: Using a database of CSCCs treated at a single institution between 2010 and 2020, we identified patients who completed Mohs surgery or non-Mohs surgical resection followed by adjuvant radiotherapy. Clinical and pathologic variables were collected from the medical record and analyzed by Fisher’s exact test, t test, and Cox proportional hazard modeling.
Results: We identified 125 cSCCs treated with surgery followed by adjuvant RT. 83.2% of patients were male, 25.6% were immunosuppressed, 29.6% had diabetes, and 14.4% were smokers. 92.8% of lesions were in the head and neck region; 64.8% of lesions extended beyond the subcutis, with a median surgical defect size of 74.1 mm. Closure types included 18.4% linear closure, 38.4% local flaps, 14.4% split- or full-thickness skin grafts, and 24.8% free flaps. All patients received adjuvant RT, to a median dose of 60 Gy / 30 fx. Overall, 18.4% of patients experienced wound healing complications (including n=11 infections, n=21 dehiscence, and n=10 need for surgical revision). On univariate analysis, defect size (HR 1.12 (95% CI 1.06-1.19), p<0.001), free flap repair type (HR 10.31 (95% CI 1.33-79.6) relative to linear closure, p=0.025), and depth deeper than subcutis (HR 3.46 (95% CI 1.02-11.61) relative to dermis/subcutis, p=0.045) were significantly associated with development of wound healing complications.
Conclusion: In our dataset, defect size, free flap repair type, and tumor depth were associated with increased risk of wound healing complications after surgery and adjuvant RT for cSCC. While limited event numbers precluded formal multivariable analysis, given the association between defect size and wound healing complications, it seems likely that the higher rate of wound healing complications seen with free flaps—which are often a favored repair type when RT is anticipated—were driven by the large size of the defects reconstructed by free flap rather than limitations of the free flap technique itself. These data suggest that a variety of repair types are likely appropriate for cSCC in the setting of adjuvant RT.