ABSTRACT
The purpose of this study was to evaluate the use of free-tissue transfers for the
reconstruction of radiation-induced complex injuries. The case files for patients
who underwent reconstruction for radiation-induced injuries between May 1988 and November
1995 at The University of Texas M.D. Anderson Cancer Center were retrospectively reviewed.
Thirty patients in whom 33 free flaps were done were included. Radiation-induced defects
were located in the head and neck (n = 23), extremities (n = 4), chest wall (n = 2),
and inguinal area (n = 1). The mean period between irradiation and injury was 78 months
(range: 4 months to 38 years). Free-tissue transfer was successful in 97 percent (32/33)
of patients. The overall complication rate was 40 percent (12/30). Flap donor sites
included the fibula (n = 12), latissimus dorsi (n = 6), rectus abdominis (n = 6),
iliac crest (n = 4), scapula (n = 3), and radial forearm (n = 2). Large-caliber vessels
in the cervical, axillary, or inguinal regions were most commonly used to revascularize
flaps. Vein grafts were used in five cases for the artery (2/5) or vein (3/5). Pedicle
thrombosis occurred in three cases in recipient vessels located within the irradiated
field. Two flaps were salvaged; one was lost, and the patient required a second free-flap
reconstruction. The mean follow-up was 40 months (range: 2.5 to 83 months). The disease-free
survival rate was 67 percent (20/30), local failures occurred in 10 percent (3/30)
of patients, and 23.3 percent (7/30) of patients either died or were lost to follow-up.
Healing of radiation-induced wounds may be achieved using free-tissue transfers, but
complications are frequent. Large-caliber irradiated vessels may be used to revascularize
flaps, but there may be an increased risk of pedicle thrombosis.
