Microsurgical Free Flap Reconstruction Outcomes in Head and Neck Cancer Patients after Surgical Extirpation and Intraoperative Brachytherapy

Abstract

IOBT increases the rate of complications in patients undergoing microvascular free tissue transfer. This, however, should not deter or alter the aggressiveness of cancer therapy used for managing recurrent head and neck cancer.

Combination of surgical resection and HDR-brachytherapy in patients with recurrent or advanced head and neck carcinomas

“…Late complications include osteoradionecrosis, carotid bleeding and fibrosis. The overall complication rate of 61% present in our study is similar to previous reports (Ross et al, 2004). In particular, the carotid ''blow-out'' is a dreaded complication following afterloading.…”

“…In particular, the carotid ''blow-out'' is a dreaded complication following afterloading. In the literature, the incidence of carotid bleeding following brachytherapy ranges from 5 to 12% (Park et al, 1991;Chen et al, 1996;Ross et al, 2004). Generally, we followed the concept that the coverage of critical structures with well-vascularized tissue of microvascular or pedicled flaps reduces the danger of wound breakdown, which is supported by several authors (Stafford and Dearnaley, 1988;Quon and Harrison, 2002).…”

Role of Perioperative Brachytherapy in the Treatment of Malignancies Involving the Skull Base and Orbit

“…5 Literature data from the head and neck region suggest that BT may enhance the complication rate of free or pedicled flap grafts but usually not seriously in the nature of complications. 44,45,89 IMBT was very well tolerated in our cases and BT in PSC cases reported by others. 11,13,16,18,20,75,83 Serious radiation-related side effects such as bone necrosis or carotid blow out have been not observed by us or others using similar techniques.…”

Biomechanical Assessment of Regenerate Integrity in Irradiated Mandibular Distraction Osteogenesis

“…Many of these risks may preclude free flap use in the elderly, 22 and worse, adjuvant therapy may be delayed because of wound-healing complications. [1][2][3][4] Distraction osteogenesis is a formidable tool for reconstructing mandibular defects. The primary application of mandibular distraction osteogenesis has been in the setting of congenital mandibular deformities [23][24][25] ; however, the use of this powerful technique for tissue replacement after oncologic resection or as a reconstructive option for deformations secondary to irradiated bone could have immense potential therapeutic ramifications.…”