Journal of Cancer Research and Clinical Oncology

, Volume 138, Issue 11, pp 1799–1811

Impact of radiotherapy on microsurgical reconstruction of the head and neck

  • Bettina Hohlweg-Majert
  • Oliver Ristow
  • Katharina Gust
  • Victoria Kehl
  • Klaus-Dietrich Wolff
  • Steffi Pigorsch
Original Paper

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.

Keywords

Microvascular reconstruction Radiotherapy Head and neck oncology Free flap 

References

  1. 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):715–718PubMedCrossRefGoogle Scholar
  2. 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 PubMedCrossRefGoogle Scholar
  3. 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):475–478PubMedCrossRefGoogle Scholar
  4. 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 PubMedCrossRefGoogle Scholar
  5. 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 PubMedCrossRefGoogle Scholar
  6. De Wilde RL, Donders G (1986) Scanning electron microscopic study of microvascular anastomoses on irradiated vessels: long-term effect of irradiation. Microsurgery 7(4):156–157PubMedCrossRefGoogle Scholar
  7. 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):662–664PubMedCrossRefGoogle Scholar
  8. 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
  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):385–389PubMedCrossRefGoogle Scholar
  10. Furnas H, Rosen JM (1991) Monitoring in microvascular surgery. Ann Plast Surg 26(3):265–272PubMedCrossRefGoogle Scholar
  11. 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):217–226PubMedCrossRefGoogle Scholar
  12. Herrmann T, Baumann M, Dörr W (2006) Klinische Strahlenbiologie, Kurz und Bündig, vol 4. Elsevier, Urban & Fischer, MünchenGoogle Scholar
  13. 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)PubMedCrossRefGoogle Scholar
  14. Hirigoyen MB, Urken ML, Weinberg H (1995) Free flap monitoring: a review of current practice. Microsurgery 16(11):723–726 (discussion 727)PubMedCrossRefGoogle Scholar
  15. 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 PubMedCrossRefGoogle Scholar
  16. 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 PubMedGoogle Scholar
  17. 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):213–216PubMedCrossRefGoogle Scholar
  18. 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)PubMedCrossRefGoogle Scholar
  19. 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
  20. 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 PubMedCrossRefGoogle Scholar
  21. 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):469–476PubMedCrossRefGoogle Scholar
  22. Machens HG, Mailaender P, Rieck B, Berger A (1994) Techniques of postoperative blood flow monitoring after free tissue transfer: an overview. Microsurgery 15(11):778–786PubMedCrossRefGoogle Scholar
  23. 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):607–612PubMedCrossRefGoogle Scholar
  24. 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):588–597PubMedCrossRefGoogle Scholar
  25. 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):16–23PubMedCrossRefGoogle Scholar
  26. Silverthorn DU (2009) Regelkreise: Antwort- und Rückkopplungsschleifen, vol 4. Pearson Education Deutschland GmbH, GermanyGoogle Scholar
  27. Sloan GM, Sasaki GH (1985) Noninvasive monitoring of tissue viability. Clin Plast Surg 12(2):185–195PubMedGoogle Scholar
  28. 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 PubMedCrossRefGoogle Scholar
  29. 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 PubMedCrossRefGoogle Scholar
  30. 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 PubMedCrossRefGoogle Scholar
  31. 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 PubMedCrossRefGoogle Scholar
  32. Vokes EE, Weichselbaum RR (1993) Measurable impact: multimodality therapy of head and neck cancer. Int J Radiat Oncol Biol Phys 27(2):481–482PubMedCrossRefGoogle Scholar
  33. 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):524–529PubMedCrossRefGoogle Scholar
  34. Yarnold J, Brotons MC (2010) Pathogenetic mechanisms in radiation fibrosis. Radiother Oncol 97(1):149–161. doi:10.1016/j.radonc.2010.09.002 PubMedCrossRefGoogle Scholar
  35. Yuen JC, Feng Z (2000) Monitoring free flaps using the laser Doppler flowmeter: five-year experience. Plast Reconstr Surg 105(1):55–61PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2012

Authors and Affiliations

  • Bettina Hohlweg-Majert
    • 1
  • Oliver Ristow
    • 1
  • Katharina Gust
    • 1
  • Victoria Kehl
    • 3
  • Klaus-Dietrich Wolff
    • 2
  • Steffi Pigorsch
    • 4
  1. 1.Clinic for Oral, Maxillofacial and Plastical SurgeryMedicine & AestheticsMunichGermany
  2. 2.Department of Oral and Maxillofacial SurgeryTechnische Universität MünchenMunichGermany
  3. 3.Institute for Medical Statistics and EpidemiologyTechnische Universität MünchenMunichGermany
  4. 4.Department of Radiation OncologyTechnische Universität MünchenMunichGermany

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