title: Microsurgical free flap transfer in previously irradiated and operated necks: feasibility and safety.
abstract: OBJECTIVE
  Microsurgery is difficult to perform in necks that have been previously irradiated and operated upon because of the limited availability of recipient vessels. The objective of this study was to clarify the feasibility and safety of performing microsurgery in necks that are scarred and fibrous owing to previous treatment.
  
  
  METHODS
  Twenty patients whose necks were previously irradiated and operated upon and who underwent free tissue transfer were included in this study. All patients had been previously administered an average of 60.7 (range, 30-95)Gy of radiotherapy. Thirteen patients had undergone hemilateral neck dissections, 5 patients had undergone bilateral neck dissections, 8 patients had undergone (pharyngo)laryngectomies, and 10 patients had undergone prior flap transfer. The success rate of microsurgery and the selection of recipient vessels were examined.
  
  
  RESULTS
  All recipient vessels could be adopted in the neck field without vessel grafting. One patient developed necrosis of the flap, which was salvaged with retransfer of another flap after trimming the same cervical vessels. For the remaining 19 patients, free tissue transfers were successful.
  
  
  CONCLUSIONS
  Suitable recipient vessels are residual and available even in the previously irradiated and operated neck field. When performed properly, free tissue transfer in the previously treated neck is not as risky a surgery as was generally believed.
authors: Department of Otorhinolaryngology and Head and Neck Surgery, Graduate School of Medical Sciences, Kyushu University, Japan. hkadota@hotmail.co.jp
authors: Hideki
authors: H
authors: Kadota
authors: Junichi
authors: J
authors: Fukushima
authors: Sei
authors: S
authors: Yoshida
authors: Kenichi
authors: K
authors: Kamizono
authors: Yoshihiko
authors: Y
authors: Kumamoto
authors: Muneyuki
authors: M
authors: Masuda
authors: Torahiko
authors: T
authors: Nakashima
authors: Ryuji
authors: R
authors: Yasumatsu
authors: Shizuo
authors: S
authors: Komune
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D058752:Free Tissue Flaps / Q000098:blood supply*; D006258:Head and Neck Neoplasms / Q000532:radiotherapy / Q000601:surgery*; D006801:Humans; D008297:Male; D008866:Microsurgery / Q000379:methods; D008875:Middle Aged; D009333:Neck / Q000098:blood supply / Q000601:surgery*; D037981:Neck Dissection; D011878:Radiotherapy / Q000009:adverse effects; D019651:Plastic Surgery Procedures / Q000379:methods; D016378:Tissue Transplantation / Q000379:methods*