title: Microvascular head and neck reconstruction after (chemo)radiation: facts and prejudices.
abstract: OBJECTIVE
  This article critically analyzes the recent literature on microvascular head and neck reconstruction after (chemo)radiation [(C)RT], taking into consideration both the underlying pathogenetic mechanisms and their clinical consequences.
  
  
  RESULTS
  Microvascular reconstruction has gradually become a mainstay in the management of head and neck cancer both in primary and salvage scenarios. However, limited data are available concerning the influence of previous radiotherapy/chemoradiation therapy (CRT) on free flap survival and surgical complications. Molecular studies show that the effects of radiotherapy/CRT may be essentially reduced to three components: inflammation, a prothrombotic state and fibrosis. From a clinical point of view, this is reflected in a moderate increase in free flaps failure and surgical complications. Nevertheless, free flaps continue to offer clear advantages even in such an unfavorable condition.
  
  
  CONCLUSIONS
  Radiotherapy/CRT induce a less favorable tissue environment, potentially leading to a higher risk of complications. In this scenario, however, free tissue transfer still plays the role of favoring wound healing bringing well vascularized tissue to less vascularized microenvironments.
authors.affiliation: aDepartment of Otorhinolaryngology - Head and Neck Surgery, University of Brescia, Brescia, ItalybDepartment of Otorhinolaryngology - Head and Neck Surgery, University of Milan, Fondazione I.R.C.C.S. Cà Granda, Milan, Italy.
authors.forename: Alberto
authors.initials: A
authors.lastname: Paderno
authors.forename: Cesare
authors.initials: C
authors.lastname: Piazza
authors.forename: Lorenzo
authors.initials: L
authors.lastname: Bresciani
authors.forename: Raimondo
authors.initials: R
authors.lastname: Vella
authors.forename: Piero
authors.initials: P
authors.lastname: Nicolai
mesh_terms: D059248:Chemoradiotherapy; D006258:Head and Neck Neoplasms / Q000601:surgery* / Q000628:therapy; D006801:Humans; D008833:Microcirculation; D019651:Plastic Surgery Procedures / Q000379:methods*; D014656:Vascular Surgical Procedures / Q000379:methods*