Vascularized free tissue transfer for reconstruction of ablative defects in oral and oropharyngeal cancer patients undergoing salvage surgery following concomitant chemoradiation

• Published in: International journal of oral and maxillofacial surgery 2012-06, Vol.41 (6), p.733-738
• Main Authors: Arce, K, Bell, R.B, Potter, J.K, Buehler, M.J, Potter, B.E, Dierks, E.J
• Format: Article
• Language: English
• Subjects: Biological and medical sciences; Bone Transplantation; Carcinoma, Squamous Cell - radiotherapy; Carcinoma, Squamous Cell - surgery; Carcinoma, Squamous Cell - therapy; Case-Control Studies; Chemoradiotherapy; Cohort Studies; complications; Dentistry; Fascia - transplantation; Female; Follow-Up Studies; free flaps; Free Tissue Flaps; Graft Survival; head and neck reconstruction; Humans; Male; Medical sciences; Middle Aged; Mouth Neoplasms - surgery; Mouth Neoplasms - therapy; Muscle, Skeletal - transplantation; Neoplasm Recurrence, Local - surgery; Neoplasm Recurrence, Local - therapy; Neoplasm Staging; Oropharyngeal Neoplasms - surgery; Oropharyngeal Neoplasms - therapy; Otorhinolaryngology. Stomatology; Postoperative Complications; Radiotherapy, High-Energy; Reconstructive Surgical Procedures - methods; Reoperation; Retrospective Studies; Salvage Therapy; Skin Transplantation; Surgery; Surgical Wound Infection - etiology; Treatment Outcome; Tumors; Upper respiratory tract, upper alimentary tract, paranasal sinuses, salivary glands: diseases, semeiology
• ISSN: 0901-5027; 1399-0020
• DOI: 10.1016/j.ijom.2012.03.004

Abstract The purpose of this study was to determine whether chemotherapy delivered concurrently with external beam radiation therapy for loco-regionally advanced head and neck cancer affects the rate or severity of postoperative complications in patients who underwent salvage surgery for recurrent or persistent disease with simultaneous microvascular free flap reconstruction. The primary study group consisted of patients with head and neck malignancies that had undergone surgical salvage with microvascular free flap reconstruction for persistent or recurrent disease following definitive radiation or concomitant chemoradiation treatment. A group of demographically matched patients who underwent microvascular free flap reconstruction for non-malignant and malignant conditions who never received radiation were randomly selected to serve as a control group. The study cohort was divided according to radiation treatment. The overall success rate of flap reconstruction was 92%, with an overall complication rate of 23%. Concurrently administered chemotherapy did not appear to affect the type of or the complication rate. The results of this investigation indicate that microvascular free flap reconstruction of head and neck defects is highly predictable, results in relatively few major complications, and suggests that neither radiation alone nor concomitant chemoradiation has a statistically significant effect on overall flap survival or complication rate.