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01.09.2012 | original article | Ausgabe 17-18/2012

Wiener klinische Wochenschrift 17-18/2012

Neoadjuvant radiotherapy of head and neck carcinoma: an obstacle for plastic reconstruction?

Zeitschrift:
Wiener klinische Wochenschrift > Ausgabe 17-18/2012
Autoren:
MD Stefan Riml, MD Franz Böhler, MD Lorenz Larcher, MD Alexander de Vries, MD Wolfgang Elsäßer, MD Peter Kompatscher

Summary

Head and neck carcinomas often are at an advanced stage at the time of diagnosis and therefore frequently primarily hardly operable. A downstaging achieved by neoadjuvant radiotherapy can facilitate a radical tumor resection. Because of radiogenic tissue alterations like scarring and impairment of blood supply, elaborate operations, such as microsurgical reconstructions, are aggravated to a degree, and most surgeons consider them impossible. In this paper, we report our experiences with plastic-surgical reconstruction in patients with neoadjuvant pretreated head and neck carcinoma.
In the last 6 years, eight patients with an advanced head and neck carcinoma were subjected to neoadjuvant radiotherapy followed by a radical tumor resection and reconstruction within the same session. Therefore, pedicled pectoralis flaps (in three patients), microvascular radialis flaps (two), lateral upper arm flaps (one), parascapular flaps (one), and a microsurgical anastomosed jejunal graft were used. The mean follow-up period was 44.5 months.
The surgical postoperative course was uneventful in 75 % of patients (six out of eight). An anastomosis venous thrombose in one patient and a wound dehiscence in another required revision. In the end, a satisfactory result could be achieved in all the patients.
Sophisticated reconstructions in irritated patients with ENT carcinoma are challenging; therefore, efficient interdisciplinary cooperation can overcome this obstacle.

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