{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,17]],"date-time":"2026-08-17T14:45:43Z","timestamp":1786977943740,"version":"build-2736575974"},"reference-count":27,"publisher":"Wiley","issue":"2","license":[{"start":{"date-parts":[[2025,9,8]],"date-time":"2025-09-08T00:00:00Z","timestamp":1757289600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2025,9,8]],"date-time":"2025-09-08T00:00:00Z","timestamp":1757289600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Head &amp; Neck"],"published-print":{"date-parts":[[2026,2]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Flap complications following maxillectomy, reconstruction, and adjuvant proton beam therapy (PBT) for primary maxillary and sinonasal malignancies are not well described.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This retrospective cohort study included consecutive patients treated between 2016 and 2023 from a single\u2010institutional database.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Thirteen patients were identified with a median follow\u2010up of 26\u2009months. No immediate post\u2010operative complications occurred, with a median time between surgery and PBT of 61\u2009days. Nine patients (69.2%) had high\u2010risk postoperative pathology and required 66+ Gy(RBE), including five (38.5%) with gross disease receiving 70\u2009Gy(RBE). Flap necrosis and fistulization occurred in three patients (23.1%) following PBT (median time from PBT to complication, 112\u2009days). Higher flap mean and minimum dose, flap volume receiving at least 66\u2009Gy[RBE], and minimum dose to 50% flap volume were associated with complications.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Careful patient selection and planning strategies should be considered to mitigate flap complication risk following adjuvant PBT for high\u2010risk post\u2010operative pathology.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/hed.70040","type":"journal-article","created":{"date-parts":[[2025,9,8]],"date-time":"2025-09-08T10:20:00Z","timestamp":1757326800000},"page":"407-415","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Flap Complications Following Maxillectomy, Reconstructive Surgery, and Postoperative Proton Radiotherapy: A Cohort Study and Considerations for Risk Mitigation"],"prefix":"10.1002","volume":"48","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6106-1374","authenticated-orcid":false,"given":"Amir H.","family":"Safavi","sequence":"first","affiliation":[{"name":"Department of Radiation Oncology Memorial Sloan Kettering Cancer Center  New York New York USA"},{"name":"Department of Radiation Oncology University of Toronto  Toronto Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fan","family":"Yang","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology Mayo Clinic Arizona  Phoenix Arizona USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yingzhi","family":"Wu","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology Memorial Sloan Kettering Cancer Center  New York New York USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ian","family":"Ganly","sequence":"additional","affiliation":[{"name":"Head and Neck Service, Department of Surgery Memorial Sloan Kettering Cancer Center  New York New York USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Evan","family":"Matros","sequence":"additional","affiliation":[{"name":"Division of Plastic and Reconstructive Surgery, Department of Surgery Memorial Sloan Kettering Cancer Center  New York New York USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Geoffrey E.","family":"Hespe","sequence":"additional","affiliation":[{"name":"Division of Plastic and Reconstructive Surgery, Department of Surgery Memorial Sloan Kettering Cancer Center  New York New York USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tony K. W.","family":"Hung","sequence":"additional","affiliation":[{"name":"Department of Medicine Memorial Sloan Kettering Cancer Center  New York New York USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7211-6246","authenticated-orcid":false,"given":"Daphna Y.","family":"Gelblum","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology Memorial Sloan Kettering Cancer Center  New York New York USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6104-7967","authenticated-orcid":false,"given":"Marc A.","family":"Cohen","sequence":"additional","affiliation":[{"name":"Head and Neck Service, Department of Surgery Memorial Sloan Kettering Cancer Center  New York New York USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Richard J.","family":"Wong","sequence":"additional","affiliation":[{"name":"Head and Neck Service, Department of Surgery Memorial Sloan Kettering Cancer Center  New York New York USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Brian","family":"Shen","sequence":"additional","affiliation":[{"name":"New York Proton Center  New York New York USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kevin","family":"Sine","sequence":"additional","affiliation":[{"name":"ProCure Proton Therapy Center  Somerset New Jersey USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dong","family":"Han","sequence":"additional","affiliation":[{"name":"New York Proton Center  New York New York USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dennis","family":"Mah","sequence":"additional","affiliation":[{"name":"ProCure Proton Therapy Center  Somerset New Jersey USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nancy Y.","family":"Lee","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology Memorial Sloan Kettering Cancer Center  New York New York USA"},{"name":"Department of Radiation Oncology University of Toronto  Toronto Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2025,9,8]]},"reference":[{"key":"e_1_2_9_2_1","doi-asserted-by":"publisher","DOI":"10.1055\/s\u20100039\u20101677701"},{"key":"e_1_2_9_3_1","doi-asserted-by":"publisher","DOI":"10.3889\/oamjms.2016.067"},{"key":"e_1_2_9_4_1","doi-asserted-by":"publisher","DOI":"10.1002\/jso.24150"},{"key":"e_1_2_9_5_1","doi-asserted-by":"publisher","DOI":"10.1001\/archoto.2011.132"},{"key":"e_1_2_9_6_1","doi-asserted-by":"publisher","DOI":"10.1097\/PRS.0b013e318221dca4"},{"key":"e_1_2_9_7_1","doi-asserted-by":"publisher","DOI":"10.1001\/archfacial.2010.18"},{"key":"e_1_2_9_8_1","doi-asserted-by":"publisher","DOI":"10.1002\/hed.21264"},{"key":"e_1_2_9_9_1","doi-asserted-by":"publisher","DOI":"10.1177\/0199820912727"},{"key":"e_1_2_9_10_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa032646"},{"key":"e_1_2_9_11_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa032641"},{"key":"e_1_2_9_12_1","doi-asserted-by":"publisher","DOI":"10.1002\/cncr.21100"},{"key":"e_1_2_9_13_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijrobp.2024.11.086"},{"key":"e_1_2_9_14_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijrobp.2021.08.027"},{"key":"e_1_2_9_15_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.canrad.2020.06.024"},{"key":"e_1_2_9_16_1","doi-asserted-by":"publisher","DOI":"10.1016\/s0025\u20106196(12)61037\u20104"},{"key":"e_1_2_9_17_1","doi-asserted-by":"publisher","DOI":"10.1002\/hed.2880130308"},{"key":"e_1_2_9_18_1","doi-asserted-by":"publisher","DOI":"10.1054\/ijom.2002.0320"},{"key":"e_1_2_9_19_1","doi-asserted-by":"publisher","DOI":"10.1001\/archotol.130.11.1308"},{"key":"e_1_2_9_20_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.oraloncology.2023.106400"},{"key":"e_1_2_9_21_1","doi-asserted-by":"publisher","DOI":"10.21873\/anticanres.17383"},{"key":"e_1_2_9_22_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.semradonc.2012.11.002"},{"key":"e_1_2_9_23_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijrobp.2024.07.2152"},{"key":"e_1_2_9_24_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijrobp.2021.08.015"},{"key":"e_1_2_9_25_1","doi-asserted-by":"publisher","DOI":"10.3390\/cancers15174268"},{"key":"e_1_2_9_26_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.radonc.2023.109973"},{"key":"e_1_2_9_27_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.prro.2024.04.003"},{"key":"e_1_2_9_28_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.radonc.2021.04.026"}],"container-title":["Head &amp; 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