title: Outcomes of microvascular free tissue transfer in twice-irradiated patients.
abstract: BACKGROUND
  Patients may require microvascular free tissue transfer (MFTT) following re-irradiation for recurrent cancer or radiation complications. The objective of this study was to describe the indications for and outcomes of free flaps performed in twice-radiated patients.
  
  
  METHODS
  A retrospective chart review identified the indications for and outcomes of 36 free flaps performed on 29 twice-irradiated patients.
  
  
  RESULTS
  The free flap success rate was 92%. The most common indications requiring MFTT were cancer recurrence and osteoradionecrosis. Sixty-one percent experienced postoperative complications, most commonly wound infection (33%). Twenty-five percent of the procedures required return to the operating room due to postoperative complication.
  
  
  CONCLUSIONS
  MFTT can be successfully performed in the twice-irradiated patient population with a success rate comparable to singly-radiated patients. Despite a high success rate, there is also a high rate of surgical site complications, especially infection.
authors.affiliation: Case Western Reserve School of Medicine, Cleveland, Ohio.
authors.forename: Kate
authors.identifier: http://orcid.org/0000-0003-2877-1408
authors.initials: K
authors.lastname: Clancy
authors.affiliation: Department of Otolaryngology, Head and Neck Surgery, University Hospitals Cleveland Medical Center, Cleveland, Ohio.
authors.forename: Sami
authors.initials: S
authors.lastname: Melki
authors.affiliation: Department of Radiation Oncology, University Hospitals Cleveland Medical Center, Cleveland, Ohio.
authors.forename: Musaddiq
authors.initials: M
authors.lastname: Awan
authors.affiliation: Department of Otolaryngology, Head and Neck Surgery, University Hospitals Cleveland Medical Center, Cleveland, Ohio.
authors.forename: Shawn
authors.initials: S
authors.lastname: Li
authors.affiliation: Department of Otolaryngology, Head and Neck Surgery, University Hospitals Cleveland Medical Center, Cleveland, Ohio.
authors.forename: Pierre
authors.initials: P
authors.lastname: Lavertu
authors.affiliation: Department of Otolaryngology, Head and Neck Surgery, University Hospitals Cleveland Medical Center, Cleveland, Ohio.
authors.forename: Nicole
authors.initials: N
authors.lastname: Fowler
authors.affiliation: Department of Radiation Oncology, University Hospitals Cleveland Medical Center, Cleveland, Ohio.
authors.forename: Min
authors.initials: M
authors.lastname: Yao
authors.affiliation: Department of Otolaryngology, Head and Neck Surgery, University Hospitals Cleveland Medical Center, Cleveland, Ohio.
authors.forename: Rod
authors.initials: R
authors.lastname: Rezaee
authors.affiliation: Department of Otolaryngology, Head and Neck Surgery, University Hospitals Cleveland Medical Center, Cleveland, Ohio.
authors.forename: Chad A
authors.initials: CA
authors.lastname: Zender
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D005260:Female; D058752:Free Tissue Flaps / Q000098:blood supply* / Q000637:transplantation; D006084:Graft Rejection; D006085:Graft Survival; D006258:Head and Neck Neoplasms / Q000469:parasitology / Q000532:radiotherapy* / Q000601:surgery; D006801:Humans; D008297:Male; D008866:Microsurgery / Q000379:methods; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000473:pathology / Q000532:radiotherapy*; D010025:Osteoradionecrosis / Q000601:surgery*; D011379:Prognosis; D011832:Radiation Injuries / Q000601:surgery; D050397:Radiotherapy, Intensity-Modulated / Q000009:adverse effects* / Q000379:methods; D019651:Plastic Surgery Procedures / Q000379:methods; D019233:Retreatment / Q000379:methods; D012189:Retrospective Studies; D018570:Risk Assessment; D014656:Vascular Surgical Procedures / Q000379:methods; D014945:Wound Healing / Q000502:physiology