nach oben

Journal of Cancer Research and Clinical Oncology

Erschienen in:

01.11.2012 | Original Paper

Impact of radiotherapy on microsurgical reconstruction of the head and neck

verfasst von: Bettina Hohlweg-Majert, Oliver Ristow, Katharina Gust, Victoria Kehl, Klaus-Dietrich Wolff, Steffi Pigorsch

Erschienen in: Journal of Cancer Research and Clinical Oncology | Ausgabe 11/2012

Einloggen, um Zugang zu erhalten

Abstract

Purpose

To examine tissue oxygenation and perfusion of free microvascular grafts after primary reconstruction, regarding outcome for patients received adjuvant radiotherapy and different types of grafts.

Patients and methods

Free microvascular grafts (n = 48) after primary reconstruction of the head and neck were examined for tissue oxygenation and perfusion over a period of 6 months. 28 patients received adjuvant radiotherapy. Using a laser doppler flowmetry combined with tissue spectroscopy of the Oxygen-to-see^®—equipment (LEA Medizintechnik, Giessen), we were able to determine oxygen saturation, hemoglobin concentration, blood flow and blood flow velocity in the graft in each of two tissue depths (2, 8 mm). Different types of graft were compared.

Result

Comparison of irradiated and non-irradiated grafts showed significant differences in tissue perfusion and oxygenation. Results for all radiated radial and fibula flaps showed no significant (p > 0.05) differences for all reviewed parameters. However, it showed no dose-volume effect with impaired functionality was found for irradiated grafts.

Conclusion

Mircovascular free tissue grafts show an increased perfusion and oxygenation after radiation compared to non-irradiated grafts.

Benediktsson KP, Celebioglu F, Perbeck LG (1997) Influence of radiation therapy on skin circulation in the breast after breast conservative surgery. Acta Oncol 36(7):715–718PubMedCrossRef

Bernier J, Domenge C, Ozsahin M, Matuszewska K, Lefebvre JL, Greiner RH, Giralt J, Maingon P, Rolland F, Bolla M, Cognetti F, Bourhis J, Kirkpatrick A, van Glabbeke M (2004) Postoperative irradiation with or without concomitant chemotherapy for locally advanced head and neck cancer. N Engl J Med 350(19):1945–1952. doi:10.1056/NEJMoa032641 PubMedCrossRef

Chalian AA, Anderson TD, Weinstein GS, Weber RS (2001) Internal jugular vein versus external jugular vein anastamosis: implications for successful free tissue transfer. Head Neck 23(6):475–478PubMedCrossRef

Choi S, Schwartz DL, Farwell DG, Austin-Seymour M, Futran N (2004) Radiation therapy does not impact local complication rates after free flap reconstruction for head and neck cancer. Arch otolaryngol Head Neck surg 130(11):1308–1312. doi:10.1001/archotol.130.11.1308 PubMedCrossRef

Cooper JS, Pajak TF, Forastiere AA, Jacobs J, Campbell BH, Saxman SB, Kish JA, Kim HE, Cmelak AJ, Rotman M, Machtay M, Ensley JF, Chao KS, Schultz CJ, Lee N, Fu KK (2004) Postoperative concurrent radiotherapy and chemotherapy for high-risk squamous-cell carcinoma of the head and neck. N Engl J Med 350(19):1937–1944. doi:10.1056/NEJMoa032646 PubMedCrossRef

De Wilde RL, Donders G (1986) Scanning electron microscopic study of microvascular anastomoses on irradiated vessels: long-term effect of irradiation. Microsurgery 7(4):156–157PubMedCrossRef

Deutsch M, Kroll SS, Ainsle N, Wang B (1999) Influence of radiation on late complications in patients with free fibular flaps for mandibular reconstruction. Ann Plast Surg 42(6):662–664PubMedCrossRef

Dietl B, Schafer C, Kolbl O (2005) The prognostic value of time parameters in adjuvant radiotherapy of head and neck cancer. A retrospective analysis of 138 patients. Strahlentherapie und Onkologie: Organ der Deutschen Rontgengesellschaft [et al.] 181(12):800–807 (discussion 808-809). doi:10.1007/s00066-005-1449-9

Disa JJ, Pusic AL, Hidalgo DH, Cordeiro PG (2001) Simplifying microvascular head and neck reconstruction: a rational approach to donor site selection. Ann Plast Surg 47(4):385–389PubMedCrossRef

Furnas H, Rosen JM (1991) Monitoring in microvascular surgery. Ann Plast Surg 26(3):265–272PubMedCrossRef

Guelinckx PJ, Boeckx WD, Fossion E, Gruwez JA (1984) Scanning electron microscopy of irradiated recipient blood vessels in head and neck free flaps. Plast Reconstr Surg 74(2):217–226PubMedCrossRef

Herrmann T, Baumann M, Dörr W (2006) Klinische Strahlenbiologie, Kurz und Bündig, vol 4. Elsevier, Urban & Fischer, München

Hidalgo DA, Disa JJ, Cordeiro PG, Hu QY (1998) A review of 716 consecutive free flaps for oncologic surgical defects: refinement in donor-site selection and technique. Plast Reconstr Surg 102(3):722–732 (discussion 733-724)PubMedCrossRef

Hirigoyen MB, Urken ML, Weinberg H (1995) Free flap monitoring: a review of current practice. Microsurgery 16(11):723–726 (discussion 727)PubMedCrossRef

Holzle F, Rau A, Swaid S, Loeffelbein DJ, Nolte D, Wolff KD (2005) Simultaneous noninvasive monitoring for radial forearm and fibula flaps using laser Doppler flowmetry and tissue spectrophotometry. Mund-, Kiefer- und Gesichtschirurgie: MKG 9(5):290–299. doi:10.1007/s10006-005-0636-2 PubMedCrossRef

Holzle F, Wolff KD, Mohr C (2008) Reconstructive oral and maxillofacial surgery. Dtsch Arztebl Int 105(47):815–822. doi:10.3238/arztebl.2008.0815 PubMed

Jose B, Banis J, Flynn M, Lindberg R, Spanos WJ Jr, Paris K, Rohm J (1991) Irradiation and free tissue transfer in head and neck cancer. Head Neck 13(3):213–216PubMedCrossRef

Kamolz LP, Giovanoli P, Haslik W, Koller R, Frey M (2002) Continuous free-flap monitoring with tissue-oxygen measurements: three-year experience. J Reconstr Microsurg 18(6):487–491. doi:10.1055/s-2002-33319 (discussion 492-483)PubMedCrossRef

Kessler P, Grabenbauer G, Leher A, Bloch-Birkholz A, Vairaktaris E, Neukam FW, Sauer R (2007) Five year survival of patients with primary oral squamous cell carcinoma. Comparison of two treatment protocols in a prospective study. Strahlentherapie und Onkologie: Organ der Deutschen Rontgengesellschaft [et al.] 183(4):184–189. doi:10.1007/s00066-007-1469-8

Lee S, Thiele C (2010) Factors associated with free flap complications after head and neck reconstruction and the molecular basis of fibrotic tissue rearrangement in preirradiated soft tissue. J oral Maxillofac Surg 68(9):2169–2178. doi:10.1016/j.joms.2009.08.026 PubMedCrossRef

Leemans CR, Chiesa F, Tradati N, Snow GB (1997) Messages from completed randomized trials in head and neck cancer. Eur J Surg Oncol 23(6):469–476PubMedCrossRef

Machens HG, Mailaender P, Rieck B, Berger A (1994) Techniques of postoperative blood flow monitoring after free tissue transfer: an overview. Microsurgery 15(11):778–786PubMedCrossRef

Numata T, Iida Y, Shiba K, Hanazawa T, Terada N, Nagata H, Konno A (2002) Usefulness of color Doppler sonography for assessing hemodynamics of free flaps for head and neck reconstruction. Ann Plast Surg 48(6):607–612PubMedCrossRef

Quarmby S, Kumar P, Wang J, Macro JA, Hutchinson JJ, Hunter RD, Kumar S (1999) Irradiation induces upregulation of CD31 in human endothelial cells. Arterioscler Thromb Vasc Biol 19(3):588–597PubMedCrossRef

Semergidis T, Vairaktaris E, Iatrou I, Carageorgis P, Martis C (1996) Blood supply to the oral and maxillofacial tissues following radiation therapy: a prospective ultrasonographic study. J Craniomaxillofac Surg 24(1):16–23PubMedCrossRef

Silverthorn DU (2009) Regelkreise: Antwort- und Rückkopplungsschleifen, vol 4. Pearson Education Deutschland GmbH, Germany

Sloan GM, Sasaki GH (1985) Noninvasive monitoring of tissue viability. Clin Plast Surg 12(2):185–195PubMed

Smith RB, Sniezek JC, Weed DT, Wax MK (2007) Utilization of free tissue transfer in head and neck surgery. Otolaryngol Head Neck Surg 137(2):182–191. doi:10.1016/j.otohns.2007.04.011 PubMedCrossRef

Suh JD, Kim BP, Abemayor E, Sercarz JA, Nabili V, Liu JH, Juillard GJ, Blackwell KE (2008) Reirradiation after salvage surgery and microvascular free flap reconstruction for recurrent head and neck carcinoma. Otolaryngol Head Neck Surg 139(6):781–786. doi:10.1016/j.otohns.2008.09.002 PubMedCrossRef

Thanik VD, Chang CC, Lerman OZ, Greives MR, Le H, Warren SM, Schneider RJ, Formenti SC, Saadeh PB, Levine JP (2010) Cutaneous low-dose radiation increases tissue vascularity through upregulation of angiogenic and vasculogenic pathways. J Vasc Res 47(6):472–480. doi:10.1159/000313875 PubMedCrossRef

Thorniley MS, Sinclair JS, Barnett NJ, Shurey CB, Green CJ (1998) The use of near-infrared spectroscopy for assessing flap viability during reconstructive surgery. Br J Plast Surg 51(3):218–226. doi:10.1054/bjps.1997.0145 PubMedCrossRef

Vokes EE, Weichselbaum RR (1993) Measurable impact: multimodality therapy of head and neck cancer. Int J Radiat Oncol Biol Phys 27(2):481–482PubMedCrossRef

Wolff KD, Marks C, Uekermann B, Specht M, Frank KH (1996) Monitoring of flaps by measurement of intracapillary haemoglobin oxygenation with EMPHO II: experimental and clinical study. Br J oral Maxillofac Surg 34(6):524–529PubMedCrossRef

Yarnold J, Brotons MC (2010) Pathogenetic mechanisms in radiation fibrosis. Radiother Oncol 97(1):149–161. doi:10.1016/j.radonc.2010.09.002 PubMedCrossRef

Yuen JC, Feng Z (2000) Monitoring free flaps using the laser Doppler flowmeter: five-year experience. Plast Reconstr Surg 105(1):55–61PubMedCrossRef

Titel: Impact of radiotherapy on microsurgical reconstruction of the head and neck
verfasst von: Bettina Hohlweg-Majert
Oliver Ristow
Katharina Gust
Victoria Kehl
Klaus-Dietrich Wolff
Steffi Pigorsch
Publikationsdatum: 01.11.2012
Verlag: Springer-Verlag
Erschienen in: Journal of Cancer Research and Clinical Oncology / Ausgabe 11/2012
Print ISSN: 0171-5216
Elektronische ISSN: 1432-1335
DOI: https://doi.org/10.1007/s00432-012-1263-6

Neu im Fachgebiet Onkologie

Nodal-negativ nach neoadjuvanter Chemo: Axilladissektion verzichtbar?

03.05.2024 Mammakarzinom Nachrichten

Wenn bei Mammakarzinomen durch eine neoadjuvante Chemotherapie ein Downstaging von nodal-positiv zu nodal-negativ gelingt, scheint es auch ohne Axilladissektion nur selten zu axillären Rezidiven zu kommen.

Wo hapert es noch bei der Umsetzung der POMGAT-Leitlinie?

03.05.2024 DCK 2024 Kongressbericht

Seit November 2023 gibt es evidenzbasierte Empfehlungen zum perioperativen Management bei gastrointestinalen Tumoren (POMGAT) auf S3-Niveau. Vieles wird schon entsprechend der Empfehlungen durchgeführt. Wo es im Alltag noch hapert, zeigt eine Umfrage in einem Klinikverbund.

Bestrahlung nach Prostatektomie: mehr Schaden als Nutzen?

02.05.2024 Prostatakarzinom Nachrichten

Eine adjuvante Radiotherapie nach radikaler Prostata-Op. bringt den Betroffenen wahrscheinlich keinen Vorteil. Im Gegenteil: Durch die Bestrahlung steigt offenbar das Risiko für Harn- und Stuhlinkontinenz.

Endlich: Zi zeigt, mit welchen PVS Praxen zufrieden sind

IT für Ärzte Nachrichten

Darauf haben viele Praxen gewartet: Das Zi hat eine Liste von Praxisverwaltungssystemen veröffentlicht, die von Nutzern positiv bewertet werden. Eine gute Grundlage für wechselwillige Ärzte und Psychotherapeuten.

Live-Webinar "Chronische Unterbauch- und Viszeralschmerzen in der Praxis managen"

Springer Medizin

Impact of radiotherapy on microsurgical reconstruction of the head and neck