Timing of radiotherapy in head and neck free flap reconstruction – a study of postoperative complications☆
Section snippets
Patients and methods
From 1984 to 2002, 221 consecutive immediate free flap reconstructions were performed after head and neck cancer resection in 216 patients at the Karolinska University Hospital. All patients were operated in one stage where the tumour resection and neck dissection were performed by a head and neck surgeon and the reconstruction by a reconstructive plastic surgery team. The free radial forearm flap was the most common type of reconstruction (Table 1). Part of the radial forearm flap material up
Results
Twenty-two complete and eight partial flap necroses occurred in the group that had received preoperative radiotherapy compared to none in the preoperatively non-irradiated group. No major differences in demographic and clinical characteristics were seen between the groups (Table 2). The radial forearm flap was the most commonly used flap and also the most common flap among flap failures (Table 3). Re-explorations were performed in 39 patients, of whom 21 had a vascular compromised flap. The
Discussion
Our results consist of two main findings. First, we found an association between preoperative radiotherapy and flap failure, when partial and total flap loss were analysed together. Second, a relationship between time elapsed from the last radiotherapy session to surgery and postoperative complications could be shown. The first result is likely to be related to complications of the anastomosis, whereas the second is a result mainly related to impaired healing of the flap into the irradiated
Acknowledgements
The authors acknowledge the work of collecting data by medical student Anna-Maria Wasner, Karolinska Institutet.
References (35)
- et al.
Experimental model for transplantation of a modified free myocutaneous gracilis flap to an irradiated neck region in rats
Int J Oral Maxillofac Surg
(2001) - et al.
Free flap transfer in rabbits using irradiated recipient vessels
Br J Plast Surg
(1978) - et al.
Free flaps and irradiated recipient vessels: an experimental study in rabbits
Br J Plast Surg
(1982) - et al.
Influence of prior radiotherapy on the development of postoperative complications and success of free tissue transfers in head and neck cancer reconstruction
Am J Surg
(1993) - et al.
Experience with microvascular free flaps in preoperatively irradiated tissue of the oral cavity and oropharynx in 303 patients
Oral Oncol
(2005) - et al.
Axillary-subclavian vein thrombosis following combination chemotherapy and radiation therapy in lymphoma
Int J Radiat Oncol Biol Phys
(1986) - et al.
Subclavian and axillary vein thrombosis following radiotherapy for carcinoma of the breast
Clin Radiol
(1987) The prothrombotic state in cancer: pathogenic mechanisms
Crit Rev Oncol Hematol
(2004)- et al.
Histopathologic damage to vessels in head and neck microsurgery
J Oral Maxillofac Surg
(2003) - et al.
Immediate reconstruction of oral cavity and oropharyngeal defects using microvascular free flaps
Am J Surg
(1978)
Preoperative radiation therapy and its effects on outcomes in microsurgical head and neck reconstruction
Otolaryngol Head Neck Surg
Factors predicting free flap complications in head and neck reconstruction
J Plast Reconstr Aesthet Surg
Pre versus post-operative radiotherapy of resectable squamous cell carcinoma of the head and neck
Acta Otolaryngol
Surgical problems in the excision and repair of radiated tissue
Plast Reconstr Surg
Radiotherapy and wound healing
Int Wound J
Radiation effects on microvascular anastomosis
Arch Otolaryngol
Does prior irradiation increase the risk of total or partial free-flap loss?
J Reconstr Microsurg
Cited by (94)
Effect of preoperative radiation on free flap outcomes for head and neck reconstruction: An updated systematic review and meta-analysis
2022, Journal of Plastic, Reconstructive and Aesthetic SurgeryRadiation Therapy and Soft Tissue Response
2021, Plastic Surgery - Principles and PracticeOsteoradionecrosis, an increasing indication for microvascular head and neck reconstruction
2020, International Journal of Oral and Maxillofacial SurgeryHead and neck cancer management and cancer stem cells implication
2019, Saudi Dental JournalComplication rates and clinical outcomes of osseous free flaps: a retrospective comparison of CAD/CAM versus conventional fixation in 128 patients
2019, International Journal of Oral and Maxillofacial SurgeryThe use of negative pressure wound therapy in the primary setting for high-risk head and neck surgery
2020, American Journal of Otolaryngology - Head and Neck Medicine and Surgery
- ☆
Presented at the 14th International Congress of the International Confederation for Plastic Reconstructive and Aesthetic Surgery (IPRAS), 29 June 2007, Berlin, Germany.