{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,8]],"date-time":"2026-07-08T05:15:02Z","timestamp":1783487702651,"version":"3.55.0"},"reference-count":24,"publisher":"MDPI AG","issue":"7","license":[{"start":{"date-parts":[[2026,6,23]],"date-time":"2026-06-23T00:00:00Z","timestamp":1782172800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Diseases"],"abstract":"<jats:p>Background: Recovery after major head-and-neck reconstruction extends beyond flap survival and wound closure, involving swallowing, psychological adaptation, body image, and overall quality of life. Integrated multidimensional assessments remain limited in routine reconstructive outcomes research. Aim: The aim of this study was to characterize and compare six-month multidimensional recovery\u2014clinical, functional, nutritional, psychological, and body-image outcomes\u2014between microvascular free-flap and regional pedicled-flap reconstruction and to identify factors that stratify risk for persistent functional and psychosocial impairment. Methods: We conducted a single-center prospective cohort study at the \u201cVictor Babe\u0219\u201d University of Medicine and Pharmacy, Timi\u0219oara, Romania, enrolling 87 adults undergoing major reconstructive surgery after ablative treatment of head-and-neck defects (52 microvascular free flaps; 35 regional pedicled flaps). Patients were assessed at baseline and 6 months using the SF-36, WHOQOL-BREF, Body Image Scale (BIS), HADS, PHQ-9, GAD-7, Functional Oral Intake Scale (FOIS), speech intelligibility, and PEG\/tracheostomy dependence. Results: At 6 months, most SF-36 and WHOQOL-BREF domains improved with moderate effect sizes (d = 0.3\u20130.7; all p \u2264 0.009), and body image distress decreased significantly (\u0394BIS \u22122.9 \u00b1 4.6; p &lt; 0.001), whereas social functioning showed no robust gain (p = 0.098; not surviving false-discovery-rate correction). Pedicled reconstruction was associated with higher PEG dependence (37.1% vs. 9.6%; p = 0.005) and worse FOIS (4.7 \u00b1 1.4 vs. 5.6 \u00b1 1.2; p = 0.003). Major complications were linked to blunted or worsening psychological trajectories and a threefold higher rate of clinically significant depression (HADS-D \u2265 11: 66.7% vs. 18.7%; p = 0.001). In a reduced four-predictor multivariable model, pedicled flap (aOR 4.6), adjuvant radiotherapy (aOR 2.8), major complication (aOR 3.3), and lower baseline FOIS (aOR 0.5 per point) were independently associated with PEG dependence (optimism-corrected AUC 0.79). Clustering identified three recovery phenotypes\u2014functional\/emotional responders, psychological\/body-image responders, and global slow recovery\u2014with significantly different PEG rates (5.9%, 21.4%, 40.0%; p = 0.006). Exploratory mediation analysis suggested that the association between reconstruction technique and mental quality-of-life recovery was partly statistically accounted for by swallowing and body-image improvement. Conclusions: Recovery after major head-and-neck reconstruction is multidimensional and heterogeneous. Baseline swallowing function, reconstruction technique, radiotherapy, and major complications jointly stratify risk for persistent functional and psychosocial impairment, supporting risk-adapted multidisciplinary rehabilitation and early psycho-oncologic screening.<\/jats:p>","DOI":"10.3390\/diseases14070226","type":"journal-article","created":{"date-parts":[[2026,6,23]],"date-time":"2026-06-23T17:11:49Z","timestamp":1782234709000},"page":"226","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Recovery Phenotypes After Head-and-Neck Reconstructive Surgery: A Prospective Cohort Comparing Free-Flap and Pedicled-Flap Pathways"],"prefix":"10.3390","volume":"14","author":[{"given":"Sonia Roxana","family":"Burtic","sequence":"first","affiliation":[{"name":"Doctoral School, \u201cVictor Babes\u201d University of Medicine and Pharmacy, Eftimie Murgu Square 2, 300041 Timisoara, Romania"},{"name":"Discipline of Medical Communications, Department II Microscopic Morphology, \u201cVictor Babes\u201d University of Medicine and Pharmacy, Eftimie Murgu Square 2, 300041 Timisoara, Romania"},{"name":"Research Center for Medical Communication, \u201cVictor Babes\u201d University of Medicine and Pharmacy, Eftimie Murgu Square 2, 300041 Timisoara, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bogdan Florin","family":"Capastraru","sequence":"additional","affiliation":[{"name":"Department XV, Disciplina Ortopedie-Traumatologie I, \u201cVictor Babes\u201d University of Medicine and Pharmacy, Eftimie Murgu Square 2, 300041 Timisoara, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0000-5714-6877","authenticated-orcid":false,"given":"Panche","family":"Taskov","sequence":"additional","affiliation":[{"name":"Discipline of Plastic and Reconstructive Surgery, Faculty of Medicine, \u201cVictor Babes\u201d University of Medicine and Pharmacy, Eftimie Murgu Square 2, 300041 Timisoara, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0007-1728-3552","authenticated-orcid":false,"given":"Daian Ionel","family":"Popa","sequence":"additional","affiliation":[{"name":"Discipline of Medical Communications, Department II Microscopic Morphology, \u201cVictor Babes\u201d University of Medicine and Pharmacy, Eftimie Murgu Square 2, 300041 Timisoara, Romania"},{"name":"Research Center for Medical Communication, \u201cVictor Babes\u201d University of Medicine and Pharmacy, Eftimie Murgu Square 2, 300041 Timisoara, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Codrina Mihaela","family":"Levai","sequence":"additional","affiliation":[{"name":"Discipline of Medical Communications, Department II Microscopic Morphology, \u201cVictor Babes\u201d University of Medicine and Pharmacy, Eftimie Murgu Square 2, 300041 Timisoara, Romania"},{"name":"Research Center for Medical Communication, \u201cVictor Babes\u201d University of Medicine and Pharmacy, Eftimie Murgu Square 2, 300041 Timisoara, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Livia","family":"Stanga","sequence":"additional","affiliation":[{"name":"Discipline of Microbiology, Faculty of Medicine, \u201cVictor Babes\u201d University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square 2, 300041 Timisoara, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Melania Lavinia","family":"Bratu","sequence":"additional","affiliation":[{"name":"Department of Neurosciences, \u201cVictor Babes\u201d University of Medicine and Pharmacy, Eftimie Murgu Square 2, 300041 Timisoara, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Adelina Maria","family":"Jianu","sequence":"additional","affiliation":[{"name":"Department of Anatomy and Embryology, Faculty of Medicine, \u201cVictor Babes\u201d University of Medicine and Pharmacy, Eftimie Murgu Square 2, 300041 Timisoara, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,6,23]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"19160216241248666","DOI":"10.1177\/19160216241248666","article-title":"Quality of Life After Head and Neck Cancer Surgery and Free Flap Reconstruction: A Systematic Review","volume":"53","author":"Gosselin","year":"2024","journal-title":"J. Otolaryngol. Head Neck Surg."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"13","DOI":"10.1186\/s40463-019-0334-y","article-title":"Free versus pedicled flaps for reconstruction of head and neck cancer defects: A systematic review","volume":"48","author":"Tabet","year":"2019","journal-title":"J. Otolaryngol. Head Neck Surg."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"343","DOI":"10.1055\/s-0041-1733922","article-title":"Postoperative Complications Associated with the Choice of Reconstruction in Head and Neck Cancer: An Outcome Analysis of 4,712 Patients from the ACS-NSQIP Database","volume":"38","author":"Katsnelson","year":"2022","journal-title":"J. Reconstr. Microsurg."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"190","DOI":"10.1002\/lary.70023","article-title":"A Longitudinal Assessment of Patient Satisfaction Following Head and Neck Free Flap Reconstruction","volume":"136","author":"Patel","year":"2026","journal-title":"Laryngoscope"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"4069","DOI":"10.1007\/s00405-021-07242-1","article-title":"Quality of life in head and neck cancer patients at 5 years after free flap reconstruction: A significant decline during the follow-up","volume":"279","author":"Lahtinen","year":"2022","journal-title":"Eur. Arch. Otorhinolaryngol."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"473","DOI":"10.1097\/00005650-199206000-00002","article-title":"The MOS 36-item short-form health survey (SF-36). I. Conceptual framework and item selection","volume":"30","author":"Ware","year":"1992","journal-title":"Med. Care"},{"key":"ref_7","doi-asserted-by":"crossref","unstructured":"The WHOQOL Group (1998). Development of the World Health Organization WHOQOL-BREF quality of life assessment. Psychol. Med., 28, 551\u2013558.","DOI":"10.1017\/S0033291798006667"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"1008","DOI":"10.1200\/JCO.1999.17.3.1008","article-title":"Quality of life in head and neck cancer patients: Validation of the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-H&N35","volume":"17","author":"Bjordal","year":"1999","journal-title":"J. Clin. Oncol."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"1516","DOI":"10.1016\/j.apmr.2004.11.049","article-title":"Initial psychometric assessment of a functional oral intake scale for dysphagia in stroke patients","volume":"86","author":"Crary","year":"2005","journal-title":"Arch. Phys. Med. Rehabil."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"9198","DOI":"10.1245\/s10434-025-17762-3","article-title":"Functional Outcomes after Subtotal\/Total Glossectomy with Microsurgical Reconstruction: A Multicenter Prospective Observational Study in Japan","volume":"32","author":"Araki","year":"2025","journal-title":"Ann. Surg. Oncol."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"361","DOI":"10.1111\/j.1600-0447.1983.tb09716.x","article-title":"The hospital anxiety and depression scale","volume":"67","author":"Zigmond","year":"1983","journal-title":"Acta Psychiatr. Scand."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"606","DOI":"10.1046\/j.1525-1497.2001.016009606.x","article-title":"The PHQ-9: Validity of a brief depression severity measure","volume":"16","author":"Kroenke","year":"2001","journal-title":"J. Gen. Intern. Med."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"1092","DOI":"10.1001\/archinte.166.10.1092","article-title":"A brief measure for assessing generalized anxiety disorder: The GAD-7","volume":"166","author":"Spitzer","year":"2006","journal-title":"Arch. Intern. Med."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"189","DOI":"10.1016\/S0959-8049(00)00353-1","article-title":"A body image scale for use with cancer patients","volume":"37","author":"Hopwood","year":"2001","journal-title":"Eur. J. Cancer"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"pkae031","DOI":"10.1093\/jncics\/pkae031","article-title":"A comprehensive examination of mental health in patients with head and neck cancer: Systematic review and meta-analysis","volume":"8","author":"Aymerich","year":"2024","journal-title":"JNCI Cancer Spectr."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"e7293","DOI":"10.1097\/GOX.0000000000007293","article-title":"Patient-reported Outcome Measures in Head and Neck Reconstruction: A Systematic Review Across Disciplines and Geographical Locations","volume":"13","author":"Pfister","year":"2025","journal-title":"Plast. Reconstr. Surg. Glob. Open"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"806","DOI":"10.1136\/bmj.39335.541782.AD","article-title":"The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) Statement: Guidelines for Reporting Observational Studies","volume":"335","author":"Altman","year":"2007","journal-title":"BMJ"},{"key":"ref_18","doi-asserted-by":"crossref","unstructured":"Ji, X., Yang, X., Jiang, Z., and Zhao, H. (2026). Pedicled versus free flap reconstruction in head and neck surgery: Analysis of complications and quality of life. BMC Surg., 26.","DOI":"10.1186\/s12893-026-03543-6"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1016\/j.bjps.2022.08.040","article-title":"Predictors of gastrostomy tube placement in patients with head and neck cancer undergoing resection and flap-based reconstruction: Systematic review and meta-analysis","volume":"79","author":"Stewart","year":"2023","journal-title":"J. Plast. Reconstr. Aesthet. Surg."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"56","DOI":"10.1016\/j.radonc.2017.08.022","article-title":"Prognostic factors for tube feeding dependence after curative (chemo-) radiation in head and neck cancer: A systematic review of literature","volume":"126","author":"Wopken","year":"2018","journal-title":"Radiother. Oncol."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"106813","DOI":"10.1016\/j.oraloncology.2024.106813","article-title":"Quality of life in 583 head and neck cancer survivors assessed with the FACE-Q head and neck cancer module","volume":"153","author":"Tonsbeek","year":"2024","journal-title":"Oral Oncol."},{"key":"ref_22","first-page":"e71081","article-title":"Assessing Postoperative Quality of Life and Psychological Impact of Free Flap Reconstruction in Advanced Head and Neck Cancer Patients","volume":"16","author":"Neamonitou","year":"2024","journal-title":"Cureus"},{"key":"ref_23","first-page":"2161","article-title":"Body image distress in head and neck cancer patients: What are we looking at?","volume":"29","author":"Melissant","year":"2021","journal-title":"Support. Care Cancer"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"150","DOI":"10.14740\/wjon1541","article-title":"Quality of Life Impacts Following Surgery for Advanced Head and Neck Cancer","volume":"14","author":"Douglas","year":"2023","journal-title":"World J. Oncol."}],"container-title":["Diseases"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2079-9721\/14\/7\/226\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,8]],"date-time":"2026-07-08T04:32:16Z","timestamp":1783485136000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2079-9721\/14\/7\/226"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,6,23]]},"references-count":24,"journal-issue":{"issue":"7","published-online":{"date-parts":[[2026,7]]}},"alternative-id":["diseases14070226"],"URL":"https:\/\/doi.org\/10.3390\/diseases14070226","relation":{},"ISSN":["2079-9721"],"issn-type":[{"value":"2079-9721","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,6,23]]}}}