Does prior irradiation increase the risk of total or partial free-flap loss?

Answers to the question, "Does previous irradiation of a recipient site interfere with reconstruction by free-tissue transfer?" have been elusive. In an attempt to address that question, all free-flap procedures performed for reconstruction of the breast or of head and neck defects at the University of Texas M. D. Anderson Cancer Center between May 1, 1988 and February 15, 1996 were reviewed. The effects of prior irradiation of the recipient site on the incidence of total flap loss, partial flap loss, and thrombosis were assessed. During the study period, 1384 eligible free-flap reconstructions were performed. Total flap loss and partial flap loss were more common in the 428 flaps transferred to previously irradiated sites than in the patients without previous irradiation, but multiple logistic regression analysis showed that these differences were due to confounding factors. The authors conclude that previous irradiation of flap recipient sites does not statistically significantly affect the rate of partial or total free-flap loss.