title: Neoadjuvant radiotherapy of head and neck carcinoma: an obstacle for plastic reconstruction?
abstract: Head and neck carcinomas often are at an advanced stage at the time of diagnosis and therefore frequently primarily hardly operable. A downstaging achieved by neoadjuvant radiotherapy can facilitate a radical tumor resection. Because of radiogenic tissue alterations like scarring and impairment of blood supply, elaborate operations, such as microsurgical reconstructions, are aggravated to a degree, and most surgeons consider them impossible. In this paper, we report our experiences with plastic-surgical reconstruction in patients with neoadjuvant pretreated head and neck carcinoma.In the last 6 years, eight patients with an advanced head and neck carcinoma were subjected to neoadjuvant radiotherapy followed by a radical tumor resection and reconstruction within the same session. Therefore, pedicled pectoralis flaps (in three patients), microvascular radialis flaps (two), lateral upper arm flaps (one), parascapular flaps (one), and a microsurgical anastomosed jejunal graft were used. The mean follow-up period was 44.5 months.The surgical postoperative course was uneventful in 75 % of patients (six out of eight). An anastomosis venous thrombose in one patient and a wound dehiscence in another required revision. In the end, a satisfactory result could be achieved in all the patients.Sophisticated reconstructions in irritated patients with ENT carcinoma are challenging; therefore, efficient interdisciplinary cooperation can overcome this obstacle.
authors: Department for Plastic, Aesthetic and Reconstructive Surgery, Academic Hospital Feldkirch, Carinagasse 47, 6807, Feldkirch, Austria. stefan.riml@lkhf.at
authors: Stefan
authors: S
authors: Riml
authors: Franz
authors: F
authors: Böhler
authors: Lorenz
authors: L
authors: Larcher
authors: Alexander
authors: A
authors: de Vries
authors: Wolfgang
authors: W
authors: Elsässer
authors: Peter
authors: P
authors: Kompatscher
mesh_terms: D000368:Aged; D000075202:Contraindications; D005260:Female; D006258:Head and Neck Neoplasms / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D020360:Neoadjuvant Therapy; D011183:Postoperative Complications / Q000209:etiology* / Q000517:prevention & control*; D018714:Radiotherapy, Adjuvant; D019651:Plastic Surgery Procedures / Q000379:methods*; D012086:Reoperation; D016896:Treatment Outcome