Pre-operative radiation therapy is considered a significant factor in head and neck reconstruction. In our consecutive series of 114 patients, 44 patients had prior head and neck irradiation while 70 patients had surgery in a non-irradiated field. Patient outcomes included total flap loss and need for revision surgery, minor flap necrosis, infection, and need for prolonged local wound care.

The patient groups were studied for demographics, tobacco and alcohol usage, and tumor stage. Observations of the groups were made for intraoperative issues such as flap size, ischemic time, and total operative time.

The two groups were compared on the basis of age, ischemic time, and flap size and found to be not statistically different. The average age of the irradiated group was 58.4 years and the average age of the non-irradiated group was 55.2 years. The average ischemic time for the irradiated group was 94.1 minutes and 102.8 minutes for the non-irradiated group. The average flap size for the irradiated group was 69.5 square centimeters and 72.0 square centimeters for the non-irradiated group. Using a single factor analysis of variance (ANOVA), we found the two groups did not statistically differ.

Patient outcomes were not affected by preoperative radiation therapy. The overall major flap complication rate for both irradiated and non-irradiated groups was approximately 10%. Of the 44 irradiated patients, there was one total flap loss and 4 patients who had major flap complications requiring early reoperation for vessel thrombosis and coverage of wound dehiscences with skin grafts and local flaps. In 70 non-irradiated patients, 7 (10%) patients required revision surgery, and all flaps were salvaged. There were 3 irradiated patients and 3 non-irradiated patients who had minor complications such as failed skin grafting and local wound dehiscence. Major and minor complication rates between the two groups did not statistically differ by Fisher’s exact test.

Microvascular reconstruction was accomplished in both irradiated and non-irradiated head and neck cancer patients with a 99% total flap survival rate and a 10% major flap complication rate. A slightly higher complication rate was noted in patients with prior irradiation who presented with recurrent disease. We conclude that prior irradiation does not increase flap complication rates in head and neck cancer reconstruction.