Microvascular Flap Reconstruction for Head and Neck Cancers in Previously Operated and/or Radiated Neck: Is It Safe?

Area of Science:

• Oncology
• Plastic Surgery
• Head and Neck Surgery

Background:

• Microvascular reconstruction in recurrent or second primary head and neck cancers presents challenges due to prior surgery and adjuvant treatments.
• Evaluating free flap success, reexploration, and failure factors in previously operated and/or radiated necks is crucial.

Purpose of the Study:

• To assess the safety and efficacy of microvascular reconstruction in already treated necks (ATN).
• To identify factors associated with reexploration and flap failure in ATN patients.

Main Methods:

• A retrospective analysis of 371 patients undergoing microvascular reconstruction in ATN between January 2016 and December 2018.
• Key variables analyzed included patient demographics, surgical history, flap details, reexploration rates, and flap survival.

Main Results:

• Free flap success rate in ATN was 90.8%, comparable to naive necks (94%).
• Reexploration rates were significantly higher in ATN (16.2%) compared to naive necks (9.8%).
• Previous neck dissection was the strongest predictor for reexploration (OR 13.7), with osteocutaneous flaps also showing higher reexploration risk.

Conclusions:

• Microvascular reconstruction is a safe option for ATN, achieving good functional outcomes despite increased reexploration rates.
• Previous neck dissection significantly increases the risk of reexploration compared to radiotherapy or chemoradiotherapy alone.