Microvascular free tissue transfer after prior radiotherapy in head and neck reconstruction - a review

Microvascular free tissue transfer has become an integral part of head and neck reconstruction. The role for it has widened in this era of organ preservation and surgical salvage. There are many reports on the influence of radiotherapy on the success of microvascular head and neck reconstruction, though there is a paucity of reports studying its effect after chemoradiotherapy. This article reviews the existing evidence regarding the influence of prior radiotherapy on microvascular free tissue transfer and sets a platform for further studies in the current setting of organ preservation with chemoradiotherapy and surgical salvage. Laboratory studies on animals, though demonstrating considerable tissue damage, could not find any influence of radiotherapy on the patency of the anastomosed vessels. Flap failure is reported to be more common after preoperative radiotherapy, but majority of the studies could not demonstrate a significant difference due to the lack of statistical power owing to the very high success rate of microvascular free flap surgery. Operative complications increased as the time between radiotherapy and surgery increased. There are very few reports on the outcome of free flap reconstruction after the organ preservation regimens of chemoradiotherapy. Such outcome studies would be coming forth in the near future.