Selection of recipient vessels for free flap following intra-arterial chemoradiotherapy

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• 作者：Keishi Kohyama^a ; ^b ; ^{casey_cybercat@yahoo.co.jp} ; Ikuo Hyodo^b ; Yasuhisa Hasegawa^c ; Nobukazu Fuwa^d ; Hisakazu Kato^a
• 关键词：Microsurgery ; Free flap ; Head and neck reconstruction ; Intra-arterial chemoradiotherapy ; Salvage surgery
• 刊名：Journal of Plastic, Reconstructive & Aesthetic Surgery
• 出版年：2017
• 出版时间：January 2017
• 年：2017
• 卷：70
• 期：1
• 页码：25-30
• 全文大小：196 K
• 卷排序：70

文摘

This study aims at selecting recipient vessels for free flap following intra-arterial chemoradiotherapy. At present, many centers combine intra-arterial chemotherapy and concomitant radiotherapy for treating head and neck cancer with favorable results. However, some patients develop recurrent, residual disease/complications after completing treatment protocols and thus require free-flap surgery. The feasibility of microsurgery following intra-arterial chemoradiotherapy remains unclear.Study design and methodsWe retrospectively analyzed 730 patients who underwent free-flap surgery for managing treatment-related complications/defects following head and neck surgery from January 1999 to February 2012. All patients were categorized into two groups according to the presence (group A)/absence (group B) of a history of intra-arterial chemotherapy. Microvascular revision rates were compared between the groups. In group A, the correlation between catheterization sites and recipient vessels used for microsurgery was assessed.ResultsA total of 769 free flaps were created in 730 patients and comprised 36 and 733 flaps in groups A and B, respectively. Microvascular revision rates were 2.8% (1/36) and 4.2% (31/733) in groups A and B, respectively, with no significant difference observed between the groups. No statistically significant difference was observed when only cases of arterial thrombosis were included. Vessels used for recipient anastomoses were not directly exposed to intra-arterially injected agents.ConclusionPreoperative intra-arterial chemoradiotherapy does not significantly increase the risk of microvascular revisions, particularly artery-related revisions, if vessels selectively catheterized and perfused with chemotherapeutic agents during intra-arterial chemotherapy are avoided as recipient vessels.