Experience with microvascular free flaps in preoperatively irradiated tissue of the oral cavity and oropharynx in 303 patients.
This study examined free flap reconstruction of surgical defects of the oral cavity and oropharynx after preoperative radiochemotherapy. Included in this analysis are 303 prospectively followed patients who underwent a multimodal treatment regime for advanced oral and oropharyngeal carcinoma. All patients received preoperative radiochemotherapy (Mitomycin C, 5-FU, 50 Gy), ablative surgery, and primary free flap reconstruction. Patient characteristics, surgical parameters like duration of surgery and ischaemia, size of defect, type of transplant, and clinical outcome parameters like duration of intensive care and hospitalization, type of complications, necessity and type of revision surgery were statistically evaluated. Overall flap success rate was 93.1%. Sixty seven patients required revision and 21 flaps (6.9%) were lost. Overall complication rate was 22.1%. Mean duration of intensive care (DOIC) and duration of overall postoperative hospitalization (DOH) were 11.0+/-9.6 days and 35.9+/-26.3 days, respectively. Flap success and flap related complications after 50 Gy focal radiation dosage were found in a comparable range as in published series of reconstructions in uncompromised tissue.
Hospital of Cranio-Maxillofacial and Oral Surgery, Medical University of Vienna, AKH, Waehringer Guertel 18-20, A-1090 Vienna, Austria. clemens.klug@meduniwien.ac.at
Clemens
C
Klug
Dominik
D
Berzaczy
Martin
M
Voracek
Georg
G
Enislidis
Thomas
T
Rath
Werner
W
Millesi
Rolf
R
Ewers
D000328:Adult; D000368:Aged; D000970:Antineoplastic Agents / Q000627:therapeutic use; D003131:Combined Modality Therapy; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009055:Mouth / Q000528:radiation effects / Q000601:surgery*; D009062:Mouth Neoplasms / Q000188:drug therapy / Q000532:radiotherapy / Q000601:surgery*; D009959:Oropharyngeal Neoplasms / Q000188:drug therapy / Q000532:radiotherapy / Q000601:surgery*; D009960:Oropharynx / Q000528:radiation effects / Q000601:surgery*; D011300:Preoperative Care; D011879:Radiotherapy Dosage; D013524:Surgical Flaps / Q000098:blood supply*
D000970:Antineoplastic Agents