title: Microvascular reconstruction after intra-arterial chemotherapy with concomitant radiation.
abstract: OBJECTIVE
  While the success of microvascular reconstruction is well established, even in the setting of prior radiotherapy, the outcomes in the setting of prior chemoradiation are less well documented. We present our experience with microvascular reconstruction in a unique cohort of patients previously treated with concomitant hyperfractionated radiation and intra-arterial chemotherapy (HYPERRADPLAT). Despite the observation in prior studies of minimal vessel damage in this setting, the hypothesis of this study is that in the late setting of most salvage surgical therapy, either for recurrence or osteoradionecrosis, a different, progressive level of vessel injury may be encountered.
  
  
  METHODS
  Case series with chart review.
  
  
  METHODS
  Tertiary referral academic medical center practice.
  
  
  METHODS
  Eighty-four patients received primary treatment for advanced head and neck squamous cell carcinoma with HYPERRADPLAT. Of these, 8 patients (10%) underwent free tissue transfer reconstruction and a total of 11 free flaps.
  
  
  RESULTS
  Wound breakdown, fistula, or both occurred postoperatively in 50% (4/8) of these patients. No complications of the venous anastomoses occurred. Fifty percent (4/8) of patients required return to surgery for arterial failure due to thrombosis of the anastomosis. Two cases of these flaps could not be salvaged.
  
  
  CONCLUSIONS
  Microvascular reconstruction following HYPERRADPLAT appears to result in a high number of arterial related complications. This experience implies an important delayed treatment effect of HYPERRADPLAT occurs upon recipient arteries. The manner in which this effect may occur in recipient arteries in the setting of more conventional chemoradiation requires further study.
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, University of Kentucky College of Medicine, Lexington, Kentucky, USA.
authors.forename: Joseph
authors.initials: J
authors.lastname: Valentino
authors.forename: W Brian
authors.initials: WB
authors.lastname: Helton
authors.forename: Raman
authors.initials: R
authors.lastname: Unnikrishnan
authors.forename: Mahesh
authors.initials: M
authors.lastname: Kudrimoti
authors.forename: Susanne M
authors.initials: SM
authors.lastname: Arnold
authors.forename: T J
authors.initials: TJ
authors.lastname: Gal
mesh_terms: D000328:Adult; D000970:Antineoplastic Agents / Q000008:administration & dosage; D002294:Carcinoma, Squamous Cell / Q000628:therapy*; D059248:Chemoradiotherapy; D002945:Cisplatin / Q000008:administration & dosage; D019583:Dose Fractionation, Radiation; D005260:Female; D058752:Free Tissue Flaps / Q000009:adverse effects; D006258:Head and Neck Neoplasms / Q000628:therapy*; D006801:Humans; D007269:Injections, Intra-Arterial; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000601:surgery; D000077195:Squamous Cell Carcinoma of Head and Neck; D016896:Treatment Outcome
chemical_list: D000970:Antineoplastic Agents; D002945:Cisplatin
keywords: chemotherapy; complication; free tissue transfer; head and neck cancer; intra-arterial; microvascular; radiation; reconstruction; regional chemotherapy; squamous cell carcinoma