OP213: Free tissue transfer for head and neck defects in salvage surgery after radiotherapy-based treatments

Abstract

To analyze the postoperative complications and success rate related to free tissue transfer for head and defects in salvage surgery after radiotherapy (RT)-based treatments. This single center study included 31 patients (median age 56 yr, male/female 22/9), who had undergone salvage surgery with free tissue transfer between 2007 and 2012. Primary sites were 15 oral cavity, eight oropharynx, eight others. All patients underwent RT during initial treatments, including 18 curative concurrent chemoradiation or RT alone and 13 adjuvant RT after surgery (including 12 neck dissections). Median period between initial treatment and salvage surgery was 7 mo (range 2–55 mo). Most common defect types were 10 pharyngeal soft tissues, followed by nine oral, six oro-mandibular and six others. Irrespective of previous neck dissections (ND), superior thyroidal arteries were reliably used as recipient arteries in 22 cases and in other cases, transverse cervical artery, superficial temporal artery, or facial artery were explored. In case of no previous ND, external jugular vein could be a useful draining vein (8/19. 42.1%), and in ND cases, internal jugular vein was used without difficulty (9/12, 75.0%). Flap-related complications occurred in eight cases (25.8%), which included three flap failure (successful salvage in one case, free flap re-do in two cases), three flap partial necrosis, one fistula formation and one wound dehiscence. Although free tissue transfer is a feasible method to reconstruct irradiated head and neck defects in salvage surgery, high postoperative complications must be taken into consideration.