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Influence of neck dissection and preoperative irradiation on microvascular head and neck reconstruction—Analysis of 853 cases
Author(s) -
Tan Ngian Chye,
Lin PaoYuan,
Chiang YuanCheng,
Chew KhongYik,
Chen ChienChung,
Fujiwara Takashi,
Kuo YurRen
Publication year - 2014
Publication title -
microsurgery
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.031
H-Index - 63
eISSN - 1098-2752
pISSN - 0738-1085
DOI - 10.1002/micr.22270
Subject(s) - medicine , neck dissection , dissection (medical) , surgery , head and neck , microsurgery , head and neck cancer , radiation therapy , cancer
Background Previous neck dissection and irradiation is believed to affect the success of free tissue transfers in head and neck reconstruction, but evidence is scarce and conflicting. This study seeks to evaluate flap success rates in the presence of these two factors. Methods Over a ten‐year period, a total of 853 free flap cases were evaluated. Success rates were compared between a control group with no prior intervention (non‐irradiation and neck dissection, NRTND) against three other groups: irradiation only (RT), previous neck dissection only (ND), and both (RTND). The choices of recipient vessel used were also compared. Results The flap failure rate was 6.3% (4/63) in the RTND group; 4.8% (1/21) in the ND group; 5.2% (6/115) in the RT group; and 2.1% (14/654) in the NRTND group. There was no statistical significance among the four groups ( P = 0.254). Ipsilateral neck vessels (92.7%) were more frequently used in the NRTND group. In contrast, the superficial temporal vessels, contra‐lateral neck vessels were more likely to be selected in the groups with irradiation and/or neck dissection. Conclusions Free tissue transfer in head and neck patients with previous irradiation and neck dissection is feasible and can be safely done. In addition, superficial temporal vessel could be the first choice in patients with previous radiotherapy and neck dissection. © 2014 Wiley Periodicals, Inc. Microsurgery 34:602–607, 2014.