Resection of tumors in irradiated fields with subsequent immediate reconstruction

With increased use of primary radiation therapy for treatment of cancer and adjuvant radiation therapy after surgical removal of a bulk tumor, recurrence in these fields has posed significant new and increasingly technical and biologic problems. We report our experience with ten such cases in which difficult wounds were reconstructed immediately after major regional resections of advanced or recurrent tumors in fields of previous irradiation. All of these patients could undergo extirpation of their recurrent tumors in irradiated fields because of improved techniques in reconstructive flap surgery allowing large amounts of well-vascularized tissue to be transferred, sometimes over a significant distance. Follow-up of these patients has ranged from three to 18 months (median, nine months). Primary healing, decreased deformity, reduced morbidity, and prolonged disease-free intervals have been achieved with the combination of extirpative and reconstructive techniques.