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ITALIAN JOURNAL OF MAXILLOFACIAL SURGERY
A Journal on Maxillofacial Surgery
Official Journal of the Italian Society of Maxillofacial Surgery
Rivista Italiana di Chirurgia Maxillo-Facciale 2004 April;15(1):15-21
Microvascular reconstruction of the cephalic region after radiotherapy and neck surgery
Biglioli F. 1, Liviero F. 1, Autelitano L. 1, Rabbiosi D. 2, Chiapasco M. 2, Brusati R. 1
1 Department of Maxillo-Facial Surgery University of Milan San Paolo Hospital, Milan
2 Department of Dentistry University of Milan, San Paolo Hospital, Milan
Aim. To research the possible influence of prior radiation treatment and prior surgery on the development of post-surgery complications in the reconstruction of the cephalic region with free flaps.
Methods. A study was made on a sample of 205 free flap cases performed to reconstruct post-oncological defects at the Maxillo-facial Surgery Department of the San Paolo Hospital in Milan, during the period April 1995-May 2004. The 205 cases were sub-divided into 4 groups according to two parameters: prior radiation treatment and prior surgical operations in the area to undergo reconstruction. Group A: 140 cases that never underwent prior treatment; Group B: 27 cases previously treated with radiotherapy; Group C: 14 cases that underwent prior ablative oncology cervicofacial surgery; GROUP D: 24 cases that previously underwent both radiotherapy and surgery. By means of a retrospective study, the four postoperative groups were observed and comparisons made regarding incidence of postoperative complications relating to free flaps.
Results. no significant differences among the 4 groups under examination were highlighted.
Conclusions. the micro-surgical operations on a previously irradiated surgical area are technically more difficult compared with surgery carried out on a non-irradiated area. These difficulties are even greater if the patient underwent prior ablative surgery. Nevertheless, on the score of results obtained, it can be stated that, with suitable technical expedients, neither a prior radiation treatment nor prior ablative surgery will significantly lead to a greater risk of postoperative complications on the free flaps.