title: Microvascular free tissue reconstruction in the patient with multiple courses of radiation.
abstract: OBJECTIVE
  To assess the feasibility of microvascular free tissue transfer in the multiply irradiated patient.
  
  
  METHODS
  Retrospective cohort analysis of 48 patients in a tertiary care, private practice setting.
  
  
  METHODS
  Inclusion criteria were defined as patients who received multiple courses of radiation and underwent subsequent free tissue reconstruction to manage treatment-related complications (n = 24) or defects following additional oncologic surgery (n = 24). The main outcome measures included total and partial flap necrosis, hardware exposure, and pharyngocutaneous fistula. The minimum follow-up was 6 months.
  
  
  RESULTS
  One case of total flap failure, two cases of partial skin paddle necrosis, one case of poor wound healing of the surrounding tissue to the flap, six cases of hardware exposure, 11 cases of fistula with eight requiring operative intervention, three cases requiring and additional free flap to supplement reconstruction, and one stroke.
  
  
  CONCLUSIONS
  Microvascular free tissue transfer to the head and neck is expected to provide a successful reconstruction in patients who have received multiple courses of radiation and who develop second primary tumors, recurrence of disease, or who suffer from late complications of their radiation therapy.
authors.affiliation: Otolaryngology and Facial Plastic Surgery Associates, Fort Worth, Texas, U.S.A.
authors.forename: Eli A
authors.initials: EA
authors.lastname: Gordin
authors.forename: Yadranko
authors.initials: Y
authors.lastname: Ducic
mesh_terms: D000328:Adult; D000368:Aged; D005240:Feasibility Studies; D005260:Female; D005500:Follow-Up Studies; D058752:Free Tissue Flaps / Q000098:blood supply*; D006085:Graft Survival; D006258:Head and Neck Neoplasms / Q000532:radiotherapy*; D006801:Humans; D008297:Male; D008833:Microcirculation; D008875:Middle Aged; D009333:Neck / Q000601:surgery*; D019651:Plastic Surgery Procedures / Q000379:methods*; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome
keywords: Microvascular free tissue transfer; complications of radiation therapy; pharyngocutaneous fistula; radionecrosis