Influence of neck dissection and preoperative irradiation on microvascular head and neck reconstruction-Analysis of 853 cases.
BACKGROUND
Previous neck dissection and irradiation is believed to affect the success of free tissue transfers in head and neck reconstruction, but evidence is scarce and conflicting. This study seeks to evaluate flap success rates in the presence of these two factors.


METHODS
Over a ten-year period, a total of 853 free flap cases were evaluated. Success rates were compared between a control group with no prior intervention (non-irradiation and neck dissection, NRTND) against three other groups: irradiation only (RT), previous neck dissection only (ND), and both (RTND). The choices of recipient vessel used were also compared.


RESULTS
The flap failure rate was 6.3% (4/63) in the RTND group; 4.8% (1/21) in the ND group; 5.2% (6/115) in the RT group; and 2.1% (14/654) in the NRTND group. There was no statistical significance among the four groups (P = 0.254). Ipsilateral neck vessels (92.7%) were more frequently used in the NRTND group. In contrast, the superficial temporal vessels, contra-lateral neck vessels were more likely to be selected in the groups with irradiation and/or neck dissection.


CONCLUSIONS
Free tissue transfer in head and neck patients with previous irradiation and neck dissection is feasible and can be safely done. In addition, superficial temporal vessel could be the first choice in patients with previous radiotherapy and neck dissection.
Department of Plastic and Reconstructive Surgery, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan; Department of Surgical Oncology, National Cancer Centre, Singapore.
Ngian Chye
NC
Tan
Pao-Yuan
PY
Lin
Yuan-Cheng
YC
Chiang
Khong-Yik
KY
Chew
Chien-Chung
CC
Chen
Takashi
T
Fujiwara
Yur-Ren
YR
Kuo
D003131:Combined Modality Therapy; D058752:Free Tissue Flaps; D006085:Graft Survival; D006258:Head and Neck Neoplasms / Q000473:pathology / Q000532:radiotherapy* / Q000601:surgery*; D006801:Humans; D008866:Microsurgery; D037981:Neck Dissection; D019651:Plastic Surgery Procedures; D012189:Retrospective Studies; D016896:Treatment Outcome