Introduction: Secondary free flap revisions entail direct skin excision and liposuction, however there is controversy with regards to the safety of revising irradiated free flaps using liposuction. The purpose of this study was to compare the outcomes of revisionary procedures requiring liposuction in irradiated versus non-irradiated flaps.

Materials and Methods: From December 1992 to July 2001, 812 free tissue transfers were performed at a single cancer center. Office and hospital records were retrospectively reviewed to identify patients who had undergone free microvascular tissue transfer and subsequent flap revision using liposuction and direct skin excision. Four groups were identified: Group 1, patients that had XRT before their free tissue transfer, Group 2, patients that had XRT after their free tissue transfer but before their flap revision, Group 3, patients that had no XRT before or after their free tissue transfer and Group 4, patients that had XRT both before and after their free tissue transfer. For each group, the number of revisions, amount of fat aspirated, timing of revision and the post-operative complications including infection, hematoma, wound dehiscence, and flap loss were reviewed.

Results: A total of 41 flap revisions using liposuction were performed on 33 free flaps (31 head and neck, 1 chest wall and 1 extremity). The rectus myocutaneous flap was the most commonly revised (88%). The amount of fat aspirated at each liposuction ranged between 10 - 300 cc. The average length of time to secondary revision (lagtime) for the entire group was 8 months (2-22). The average lagtime for each group was as follows: Group 1 - 7.5 months (2-22), Group 2 - 9.6 months (3-22), Group 3 - 6.9 months (3-12), and Group 4 - 11 months (4-16). The lagtime of patients who had received postoperative radiotherapy to their flaps (Groups 2&4) was significantly higher that those who had not been treated with external beam radiation (Groups 1&3), p < 0.05. There were no postoperative infections, hematoma, wound dehiscence, or total flap losses. There was one partial (20%) flap loss in a Group 2 patient requiring local wound care. The difference in complication rates among various groups was not statistically significant.

Conclusions: There was no significant difference in complication rates for irradiated and non-irradiated flaps. Postoperative radiation therapy is therefore not a contraindication to secondary revision using liposuction. However, these procedures should be delayed for several months after the acute effects of radiation have resolved.