Alberto Paderno1, Cesare Piazza, Lorenzo Bresciani, Raimondo Vella, Piero Nicolai. 1. aDepartment of Otorhinolaryngology - Head and Neck Surgery, University of Brescia, Brescia, ItalybDepartment of Otorhinolaryngology - Head and Neck Surgery, University of Milan, Fondazione I.R.C.C.S. Cà Granda, Milan, Italy.
Abstract
PURPOSE OF REVIEW: This article critically analyzes the recent literature on microvascular head and neck reconstruction after (chemo)radiation [(C)RT], taking into consideration both the underlying pathogenetic mechanisms and their clinical consequences. RECENT FINDINGS: Microvascular reconstruction has gradually become a mainstay in the management of head and neck cancer both in primary and salvage scenarios. However, limited data are available concerning the influence of previous radiotherapy/chemoradiation therapy (CRT) on free flap survival and surgical complications. Molecular studies show that the effects of radiotherapy/CRT may be essentially reduced to three components: inflammation, a prothrombotic state and fibrosis. From a clinical point of view, this is reflected in a moderate increase in free flaps failure and surgical complications. Nevertheless, free flaps continue to offer clear advantages even in such an unfavorable condition. SUMMARY: Radiotherapy/CRT induce a less favorable tissue environment, potentially leading to a higher risk of complications. In this scenario, however, free tissue transfer still plays the role of favoring wound healing bringing well vascularized tissue to less vascularized microenvironments.
PURPOSE OF REVIEW: This article critically analyzes the recent literature on microvascular head and neck reconstruction after (chemo)radiation [(C)RT], taking into consideration both the underlying pathogenetic mechanisms and their clinical consequences. RECENT FINDINGS: Microvascular reconstruction has gradually become a mainstay in the management of head and neck cancer both in primary and salvage scenarios. However, limited data are available concerning the influence of previous radiotherapy/chemoradiation therapy (CRT) on free flap survival and surgical complications. Molecular studies show that the effects of radiotherapy/CRT may be essentially reduced to three components: inflammation, a prothrombotic state and fibrosis. From a clinical point of view, this is reflected in a moderate increase in free flaps failure and surgical complications. Nevertheless, free flaps continue to offer clear advantages even in such an unfavorable condition. SUMMARY: Radiotherapy/CRT induce a less favorable tissue environment, potentially leading to a higher risk of complications. In this scenario, however, free tissue transfer still plays the role of favoring wound healing bringing well vascularized tissue to less vascularized microenvironments.
Authors: K S Rathan Shetty; Vinayak Kurle; P Greeshma; Veena B Ganga; Samskruthi P Murthy; Siddappa K Thammaiah; P Krishna Prasad; Purushottham Chavan; Rajshekar Halkud; R Krishnappa Journal: Front Oral Health Date: 2022-01-28
Authors: Maximilian Gottsauner; Clara Fehrer; Steffen Spoerl; Johannes Schuderer; Florian Zeman; Mathias Fiedler; Michael Maurer; Torsten E Reichert; Tobias Ettl Journal: J Clin Med Date: 2022-08-27 Impact factor: 4.964