Skip to main content

Advertisement

SpringerLink
Log in

Impact of radiotherapy on microsurgical reconstruction of the head and neck

  • Original Paper
  • Published:
Journal of Cancer Research and Clinical Oncology Aims and scope Submit manuscript

Abstract

Purpose

To examine tissue oxygenation and perfusion of free microvascular grafts after primary reconstruction, regarding outcome for patients received adjuvant radiotherapy and different types of grafts.

Patients and methods

Free microvascular grafts (n = 48) after primary reconstruction of the head and neck were examined for tissue oxygenation and perfusion over a period of 6 months. 28 patients received adjuvant radiotherapy. Using a laser doppler flowmetry combined with tissue spectroscopy of the Oxygen-to-see®—equipment (LEA Medizintechnik, Giessen), we were able to determine oxygen saturation, hemoglobin concentration, blood flow and blood flow velocity in the graft in each of two tissue depths (2, 8 mm). Different types of graft were compared.

Result

Comparison of irradiated and non-irradiated grafts showed significant differences in tissue perfusion and oxygenation. Results for all radiated radial and fibula flaps showed no significant (p > 0.05) differences for all reviewed parameters. However, it showed no dose-volume effect with impaired functionality was found for irradiated grafts.

Conclusion

Mircovascular free tissue grafts show an increased perfusion and oxygenation after radiation compared to non-irradiated grafts.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6
Fig. 7
Fig. 8

Similar content being viewed by others

References

  • Benediktsson KP, Celebioglu F, Perbeck LG (1997) Influence of radiation therapy on skin circulation in the breast after breast conservative surgery. Acta Oncol 36(7):715–718

    Article  PubMed  CAS  Google Scholar 

  • Bernier J, Domenge C, Ozsahin M, Matuszewska K, Lefebvre JL, Greiner RH, Giralt J, Maingon P, Rolland F, Bolla M, Cognetti F, Bourhis J, Kirkpatrick A, van Glabbeke M (2004) Postoperative irradiation with or without concomitant chemotherapy for locally advanced head and neck cancer. N Engl J Med 350(19):1945–1952. doi:10.1056/NEJMoa032641

    Article  PubMed  CAS  Google Scholar 

  • Chalian AA, Anderson TD, Weinstein GS, Weber RS (2001) Internal jugular vein versus external jugular vein anastamosis: implications for successful free tissue transfer. Head Neck 23(6):475–478

    Article  PubMed  CAS  Google Scholar 

  • Choi S, Schwartz DL, Farwell DG, Austin-Seymour M, Futran N (2004) Radiation therapy does not impact local complication rates after free flap reconstruction for head and neck cancer. Arch otolaryngol Head Neck surg 130(11):1308–1312. doi:10.1001/archotol.130.11.1308

    Article  PubMed  Google Scholar 

  • Cooper JS, Pajak TF, Forastiere AA, Jacobs J, Campbell BH, Saxman SB, Kish JA, Kim HE, Cmelak AJ, Rotman M, Machtay M, Ensley JF, Chao KS, Schultz CJ, Lee N, Fu KK (2004) Postoperative concurrent radiotherapy and chemotherapy for high-risk squamous-cell carcinoma of the head and neck. N Engl J Med 350(19):1937–1944. doi:10.1056/NEJMoa032646

    Article  PubMed  Google Scholar 

  • De Wilde RL, Donders G (1986) Scanning electron microscopic study of microvascular anastomoses on irradiated vessels: long-term effect of irradiation. Microsurgery 7(4):156–157

    Article  PubMed  Google Scholar 

  • Deutsch M, Kroll SS, Ainsle N, Wang B (1999) Influence of radiation on late complications in patients with free fibular flaps for mandibular reconstruction. Ann Plast Surg 42(6):662–664

    Article  PubMed  CAS  Google Scholar 

  • Dietl B, Schafer C, Kolbl O (2005) The prognostic value of time parameters in adjuvant radiotherapy of head and neck cancer. A retrospective analysis of 138 patients. Strahlentherapie und Onkologie: Organ der Deutschen Rontgengesellschaft [et al.] 181(12):800–807 (discussion 808-809). doi:10.1007/s00066-005-1449-9

  • Disa JJ, Pusic AL, Hidalgo DH, Cordeiro PG (2001) Simplifying microvascular head and neck reconstruction: a rational approach to donor site selection. Ann Plast Surg 47(4):385–389

    Article  PubMed  CAS  Google Scholar 

  • Furnas H, Rosen JM (1991) Monitoring in microvascular surgery. Ann Plast Surg 26(3):265–272

    Article  PubMed  CAS  Google Scholar 

  • Guelinckx PJ, Boeckx WD, Fossion E, Gruwez JA (1984) Scanning electron microscopy of irradiated recipient blood vessels in head and neck free flaps. Plast Reconstr Surg 74(2):217–226

    Article  PubMed  CAS  Google Scholar 

  • Herrmann T, Baumann M, Dörr W (2006) Klinische Strahlenbiologie, Kurz und Bündig, vol 4. Elsevier, Urban & Fischer, München

    Google Scholar 

  • Hidalgo DA, Disa JJ, Cordeiro PG, Hu QY (1998) A review of 716 consecutive free flaps for oncologic surgical defects: refinement in donor-site selection and technique. Plast Reconstr Surg 102(3):722–732 (discussion 733-724)

    Article  PubMed  CAS  Google Scholar 

  • Hirigoyen MB, Urken ML, Weinberg H (1995) Free flap monitoring: a review of current practice. Microsurgery 16(11):723–726 (discussion 727)

    Article  PubMed  CAS  Google Scholar 

  • Holzle F, Rau A, Swaid S, Loeffelbein DJ, Nolte D, Wolff KD (2005) Simultaneous noninvasive monitoring for radial forearm and fibula flaps using laser Doppler flowmetry and tissue spectrophotometry. Mund-, Kiefer- und Gesichtschirurgie: MKG 9(5):290–299. doi:10.1007/s10006-005-0636-2

    Article  PubMed  CAS  Google Scholar 

  • Holzle F, Wolff KD, Mohr C (2008) Reconstructive oral and maxillofacial surgery. Dtsch Arztebl Int 105(47):815–822. doi:10.3238/arztebl.2008.0815

    PubMed  Google Scholar 

  • Jose B, Banis J, Flynn M, Lindberg R, Spanos WJ Jr, Paris K, Rohm J (1991) Irradiation and free tissue transfer in head and neck cancer. Head Neck 13(3):213–216

    Article  PubMed  CAS  Google Scholar 

  • Kamolz LP, Giovanoli P, Haslik W, Koller R, Frey M (2002) Continuous free-flap monitoring with tissue-oxygen measurements: three-year experience. J Reconstr Microsurg 18(6):487–491. doi:10.1055/s-2002-33319 (discussion 492-483)

    Article  PubMed  Google Scholar 

  • Kessler P, Grabenbauer G, Leher A, Bloch-Birkholz A, Vairaktaris E, Neukam FW, Sauer R (2007) Five year survival of patients with primary oral squamous cell carcinoma. Comparison of two treatment protocols in a prospective study. Strahlentherapie und Onkologie: Organ der Deutschen Rontgengesellschaft [et al.] 183(4):184–189. doi:10.1007/s00066-007-1469-8

  • Lee S, Thiele C (2010) Factors associated with free flap complications after head and neck reconstruction and the molecular basis of fibrotic tissue rearrangement in preirradiated soft tissue. J oral Maxillofac Surg 68(9):2169–2178. doi:10.1016/j.joms.2009.08.026

    Article  PubMed  Google Scholar 

  • Leemans CR, Chiesa F, Tradati N, Snow GB (1997) Messages from completed randomized trials in head and neck cancer. Eur J Surg Oncol 23(6):469–476

    Article  PubMed  CAS  Google Scholar 

  • Machens HG, Mailaender P, Rieck B, Berger A (1994) Techniques of postoperative blood flow monitoring after free tissue transfer: an overview. Microsurgery 15(11):778–786

    Article  PubMed  CAS  Google Scholar 

  • Numata T, Iida Y, Shiba K, Hanazawa T, Terada N, Nagata H, Konno A (2002) Usefulness of color Doppler sonography for assessing hemodynamics of free flaps for head and neck reconstruction. Ann Plast Surg 48(6):607–612

    Article  PubMed  Google Scholar 

  • Quarmby S, Kumar P, Wang J, Macro JA, Hutchinson JJ, Hunter RD, Kumar S (1999) Irradiation induces upregulation of CD31 in human endothelial cells. Arterioscler Thromb Vasc Biol 19(3):588–597

    Article  PubMed  CAS  Google Scholar 

  • Semergidis T, Vairaktaris E, Iatrou I, Carageorgis P, Martis C (1996) Blood supply to the oral and maxillofacial tissues following radiation therapy: a prospective ultrasonographic study. J Craniomaxillofac Surg 24(1):16–23

    Article  PubMed  CAS  Google Scholar 

  • Silverthorn DU (2009) Regelkreise: Antwort- und Rückkopplungsschleifen, vol 4. Pearson Education Deutschland GmbH, Germany

    Google Scholar 

  • Sloan GM, Sasaki GH (1985) Noninvasive monitoring of tissue viability. Clin Plast Surg 12(2):185–195

    PubMed  CAS  Google Scholar 

  • Smith RB, Sniezek JC, Weed DT, Wax MK (2007) Utilization of free tissue transfer in head and neck surgery. Otolaryngol Head Neck Surg 137(2):182–191. doi:10.1016/j.otohns.2007.04.011

    Article  PubMed  Google Scholar 

  • Suh JD, Kim BP, Abemayor E, Sercarz JA, Nabili V, Liu JH, Juillard GJ, Blackwell KE (2008) Reirradiation after salvage surgery and microvascular free flap reconstruction for recurrent head and neck carcinoma. Otolaryngol Head Neck Surg 139(6):781–786. doi:10.1016/j.otohns.2008.09.002

    Article  PubMed  Google Scholar 

  • Thanik VD, Chang CC, Lerman OZ, Greives MR, Le H, Warren SM, Schneider RJ, Formenti SC, Saadeh PB, Levine JP (2010) Cutaneous low-dose radiation increases tissue vascularity through upregulation of angiogenic and vasculogenic pathways. J Vasc Res 47(6):472–480. doi:10.1159/000313875

    Article  PubMed  CAS  Google Scholar 

  • Thorniley MS, Sinclair JS, Barnett NJ, Shurey CB, Green CJ (1998) The use of near-infrared spectroscopy for assessing flap viability during reconstructive surgery. Br J Plast Surg 51(3):218–226. doi:10.1054/bjps.1997.0145

    Article  PubMed  CAS  Google Scholar 

  • Vokes EE, Weichselbaum RR (1993) Measurable impact: multimodality therapy of head and neck cancer. Int J Radiat Oncol Biol Phys 27(2):481–482

    Article  PubMed  CAS  Google Scholar 

  • Wolff KD, Marks C, Uekermann B, Specht M, Frank KH (1996) Monitoring of flaps by measurement of intracapillary haemoglobin oxygenation with EMPHO II: experimental and clinical study. Br J oral Maxillofac Surg 34(6):524–529

    Article  PubMed  CAS  Google Scholar 

  • Yarnold J, Brotons MC (2010) Pathogenetic mechanisms in radiation fibrosis. Radiother Oncol 97(1):149–161. doi:10.1016/j.radonc.2010.09.002

    Article  PubMed  CAS  Google Scholar 

  • Yuen JC, Feng Z (2000) Monitoring free flaps using the laser Doppler flowmeter: five-year experience. Plast Reconstr Surg 105(1):55–61

    Article  PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Clinic for Oral, Maxillofacial and Plastical Surgery, Medicine & Aesthetics, Lenbachplatz 2a, 80333, Munich, Germany

    Bettina Hohlweg-Majert, Oliver Ristow & Katharina Gust

  2. Department of Oral and Maxillofacial Surgery, Technische Universität München, Ismaninger Str. 22, 81675, Munich, Germany

    Klaus-Dietrich Wolff

  3. Institute for Medical Statistics and Epidemiology, Technische Universität München, Ismaninger Straße 22, 81675, Munich, Germany

    Victoria Kehl

  4. Department of Radiation Oncology, Technische Universität München, Ismaninger Str. 22, 81675, Munich, Germany

    Steffi Pigorsch

Authors
  1. Bettina Hohlweg-Majert
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Oliver Ristow
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Katharina Gust
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Victoria Kehl
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Klaus-Dietrich Wolff
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Steffi Pigorsch
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Oliver Ristow.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Hohlweg-Majert, B., Ristow, O., Gust, K. et al. Impact of radiotherapy on microsurgical reconstruction of the head and neck. J Cancer Res Clin Oncol 138, 1799–1811 (2012). https://doi.org/10.1007/s00432-012-1263-6

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00432-012-1263-6

Keywords

Search

Navigation