Feasibility of flap reconstruction in conjunction with intraoperative radiation therapy for advanced and recurrent head and neck cancer.
BACKGROUND
Radiation is a known risk factor for poor wound healing. Patients undergoing intraoperative radiation therapy (IORT) typically receive higher cumulative doses to their wound beds than patients treated with conventional radiation therapy. We review our experience with IORT in patients undergoing resection of head and neck cancer and flap reconstruction. Logistics of delivery and outcomes are discussed.


METHODS
A retrospective chart review was performed on all patients at Beth Israel Medical Center who underwent IORT for head and neck cancer between 2000 and 2007. Twenty-one patients receiving 22 treatments involving flap reconstruction were identified. The results of these reconstructions were evaluated for complications and functional outcome.


RESULTS
All patients had complex surgical wounds of the face, upper aerodigestive tract, or neck who received IORT in conjunction with pedicled or free flap closure. Twenty-five flaps in 21 patients were performed in the setting of IORT. All patients received between 10 and 15 Gy of IORT administered directly to the wound bed. There were no perioperative mortalities. Wound breakdown occurred in three cases, all of which were treated successfully by operative revision. Functionally, most patients did well and performed similarly to historic controls for their type of reconstruction.


CONCLUSIONS
Reconstruction using flaps in the context of IORT can be achieved with expectation of good wound healing in the majority of cases despite heavy cumulative doses of radiation to recipient wound beds.
Most
Michael D
MD
Department of General Surgery, Division of Head and Neck Surgery, Beth Israel Medical Center, New York, NY, U.S.A. michaelmostmd@yahoo.com
Allori
Alexander C
AC
Hu
Kenneth
K
Urken
Mark L
ML
Persky
Mark S
MS
Sessions
Roy B
RB
Nussbaum
Moses
M
Harrison
Louis B
LB
Frank
Douglas K
DK
Smith
Mark L
ML
D000230:Adenocarcinoma / Q000532:radiotherapy / Q000601:surgery; D000293:Adolescent; D000328:Adult; D000368:Aged; D002294:Carcinoma, Squamous Cell / Q000532:radiotherapy / Q000601:surgery; D005240:Feasibility Studies; D005260:Female; D005500:Follow-Up Studies; D006258:Head and Neck Neoplasms / Q000532:radiotherapy* / Q000601:surgery; D006801:Humans; D007430:Intraoperative Care; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000532:radiotherapy* / Q000601:surgery; D011183:Postoperative Complications; D015642:Radiology, Interventional; D011879:Radiotherapy Dosage; D019651:Plastic Surgery Procedures / Q000379:methods*; D012086:Reoperation; D012189:Retrospective Studies; D013524:Surgical Flaps; D013529:Surgical Wound Dehiscence / Q000209:etiology; D016896:Treatment Outcome; D014945:Wound Healing / Q000502:physiology