Reconstructive Microsurgery and Radiotherapy in Advanced Tumors of the Head and Neck

The possibilities for reconstruction have increased substantially with the development of microsurgery. Microvascular free tissue transplantation is now an established procedure in head and neck surgery. Nearly every specific tissue defect can be repaired with appropriate donor tissue. Radiation therapy is very often combined with surgery of head and neck tumors. The different treatment modalities — pre- or postoperative irradiation — also influence the reconstructive procedures. Especially when a microvascular transfer is planned, the status of the recipient vessels is of utmost importance. Irradiated vessels show thickening of all parts of the vessel wall and fibrosis of the surrounding tissue. Therefore exact preoperative planning is necessary before any free flap transplantation. One has to distinguish between primary reconstruction and secondary reconstruction of the defect after tumor resection: in both cases the vessels can be irradiated beforehand but the situation is not the same.