INFLUENCE OF PRIOR RADIOTHERAPY ON THE DEVELOPMENT OF POSTOPERATIVE COMPLICATIONS AND SUCCESS OF FREE TISSUE TRANSFERS IN HEAD AND NECK-CANCER RECONSTRUCTION

The purpose of this study was to determine whether prior radiotherapy had any effect on the development of postoperative complications in pa tients undergoing microvascular tissue transfers for reconstruction of head and neck cancer. A prospective database was used to review 354 c onsecutive patients who had a total of 368 free tissue transfers limit ed to the head and neck during the 4-year period from July 1988 to Jun e 1992. Postoperative complications in 167 patients who received preop erative radiotherapy (XRT) were compared with those of 187 patients wh o did not undergo radiotherapy preoperatively (NR). No statistical dif ferences in complications or flap loss between the two groups were not ed using the chi2 test or Fisher's exact test (p >0.2). Total flap los s occurred in 5.3% of the XRT group (9 of 169) and 5.0% of the NR pati ent group (10 of 199), and partial flap loss occurred in 4.1% of the i rradiated patients and 2.5% of the nonirradiated patients. Major wound complications requiring additional surgery occurred in 16% of the XRT group and 11% of the NR group. Minor wound complications that did not require further surgery occurred in 21% of the irradiated patients an d 18% of the nonirradiated patients. No significant difference in the timing or dose of preoperative radiation, previous neck dissection, or anastomotic type could be documented in failed versus successful flap s (two-tailed t-test, p >0.80, and chi2, p >0.2). Our results show tha t, in a large group of cancer patients undergoing free tissue transfer s to the head and neck, prior radiotherapy or surgery did not predispo se them to a higher rate of acute flap loss or wound complications tha n their nonirradiated cohorts.