Simultaneous Interstitial Radiotherapy With Regional or Free-Flap Reconstruction, Following Salvage Surgery of Recurrent Head and Neck Carcinoma: Analysis of Complications

Objective: Reports on complications following brachy-therapy offer conflicting views on the benefit of locoregional flap coverage of the implanted tumor bed. This study reviews complications following pedicled and free-flap coverage of brachytherapy sources after salvage surgery for recurrent head and neck carcinoma. Design: Retrospective chart review. Setting: Academic tertiary referral center. Participants: Fifteen patients with advanced, radiore-current carcinomas of the head and neck, treated between 1988 and 1992. Intervention: All patients underwent surgical resection and implantation of the tumor bed with iridium 192 after-loading catheters (13 patients) or iodine 125 seeds (two patients). The average dose ofinterstitial radiotherapysupplied was50.24-45.19Gy (mean-SD). Coverageofthe implanted tumor bed was achieved with regional myocutaneous flaps in 10 patients and microvascular free flaps in five patients. Outcome Measure: All wound and healing complications were identified. Patients were followed up for a minimum of 3 months. Results: No significant complications were encountered. No flap, pedicled or free, demonstrated any degree of necrosis. Four minor complications developed in the group of patients who underwent reconstruction with pedicled myocutaneous flaps. One orocutaneous fistula developed in a patient in whom a radial forearm was used to reconstruct a posterior pharyngeal wall defect. Conclusions: An expectation of increased postoperative morbidity should not interfere with the decision to proceed with multimodality salvage therapy of patients with advanced, recurrent head and neck tumors. The advantages of free tissue transfer in the reconstruction of head and neck defects are not compromised when the flaps are simultaneously utilized to provide coverage for brachytherapy sites.