Free flaps and irradiated recipient vessels: an experimental study in rabbits

Krag, Christen; Rose, Guy De; Lyczakowski, Tadeusz; Freeman, Carolyn R.; Shapiro, Stanley H.

doi:10.1016/s0007-1226(82)90122-9

Cited by 60 publications

(40 citation statements)

References 7 publications

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“…1,2 The in vivo effect of XRT on free flap viability was initially studied in animal models. Krag et al 3 showed that adminstering XRT to recipient vessels in rabbits before surgery significantly increased free flap failure rates. Other groups have presented conflicting results, showing that radiating recipient vessels in rats before surgery did not adversely effect free flap viability.…”

Section: Discussionmentioning

confidence: 99%

Radiation Therapy Does Not Impact Local Complication Rates After Free Flap Reconstruction for Head and Neck Cancer

Choi¹,

Schwartz²,

Farwell³

et al. 2004

Arch Otolaryngol Head Neck Surg

111

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Section: Discussionmentioning

confidence: 99%

Radiation Therapy Does Not Impact Local Complication Rates After Free Flap Reconstruction for Head and Neck Cancer

Choi¹,

Schwartz²,

Farwell³

et al. 2004

Arch Otolaryngol Head Neck Surg

111

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show abstract

“…Usually one end-toend or end-to-side arterial anastomosis and two end-to-end venous anastomoses were made. To protect the blood supply to the graft, we tried to place the vessel anastomoses outside areas treated with radiotherapy (Krag et al 1982). All the patients were given prophylactic antibiotics.…”

Section: Operative Technique and Aftercarementioning

confidence: 99%

Reconstruction with a free vascularized fibular graft for malignant bone tumor

Åberg

Rydholm

Holmberg

et al. 1988

Acta Orthopaedica Scandinavica

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“…It is unclear, however, whether neoadjuvant radiotherapy may inadvertently complicate microsurgical reconstruction in the process. Animal studies suggest it is detrimental to fl ap survival [19][20][21], whereas clinical studies found it to have no appreciable effect [22][23][24]. In our study, irradiated random-pattern fl aps performed similarly to control group fl aps in the proximal half and outperformed control group fl aps in the distal half.…”

Section: Discussionmentioning

confidence: 40%

Effects of Neoadjuvant Chemotherapy and Radiotherapy on Flap Perfusion in a Novel Mouse Model Using Standard Clinical Assessment and Near-Infrared Fluorescence Angiography

Ramesh¹,

Moore²,

Patel³

et al. 2017

Arch Otolaryngol Rhinold

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IntoductionThe clinical management of locally advanced cancers of the head and neck pose a signifi cant therapeutic challenge [1]. Despite advances in the fi eld, including the routine use of microvascular free tissue transfers in the reconstruction of defects, fl ap failure persists as a troublesome complication 2 . The underlying factors that infl uence the development of fl ap failure are varied and complex, including comorbid systemic diseases, positive surgical margins, lymph node metastases, and prior radiotherapy and/or chemotherapy [1][2][3].Radiation and chemotherapy are often administered neoadjuvantly, or prior to surgical intervention, to gauge Abstract Purpose: Minimizing surgical morbidity after local fl ap reconstruction is important in the management of cutaneous defects. Controversy exists in current literature regarding the effects of radiation and chemotherapy on fl ap perfusion. Neoadjuvant treatments can damage the microvasculature of the surgical bed through fi brosis, endothelial cell damage, and reduced cell proliferation, which collectively increase the likelihood of postoperative fl ap failure. The aim of this study is to examine the effects of neoadjuvant radiation and chemotherapy on skin fl ap perfusion.Methods: Animals were divided into three groups: control (no treatment, n=4), radiation group (36-Gy administered to dorsal skin, n=4), and chemotherapy group (2 mg/kg IP cisplatin, n=4). Treatments were performed 15 days prior to random-pattern dorsal fl ap surgery, with a fl ap length-to-width ratio of 4:1 (4x1cm2). Flap perfusion was assessed via laser-assisted (Luna, Novadaq) indocyanine green dye angiography and standard clinical assessment. Results:Fluorescence imaging was used to quantify fl ap perfusion as a fraction of healthy skin perfusion. Chemotherapy group fl aps had poorer distal end perfusion than radiation or control group fl aps (56% vs. 69% and 71%, respectively) on post-operative day (POD) 1. Clinical assessment of fl ap perfusion by experienced surgeons on POD2 found chemotherapy group fl aps to be least viable. By POD5, 100% of chemotherapy group fl aps had experienced complete fl ap loss as measured by clinical evaluation and perfusion imaging. Conclusion:Flaps receiving neoadjuvant chemotherapy performed worse than those receiving local radiotherapy or no treatment. We demonstrate the detrimental effect of neoadjuvant chemotherapy on fl ap viability in this preclinical murine model.

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Free flaps and irradiated recipient vessels: an experimental study in rabbits

Cited by 60 publications

References 7 publications

Radiation Therapy Does Not Impact Local Complication Rates After Free Flap Reconstruction for Head and Neck Cancer

Radiation Therapy Does Not Impact Local Complication Rates After Free Flap Reconstruction for Head and Neck Cancer

Reconstruction with a free vascularized fibular graft for malignant bone tumor

Effects of Neoadjuvant Chemotherapy and Radiotherapy on Flap Perfusion in a Novel Mouse Model Using Standard Clinical Assessment and Near-Infrared Fluorescence Angiography

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