Background: Performing secondary head and neck reconstructive surgery after radiotherapy is highly challenging. We report the outcomes of this type of procedure.
Methods: We retrospectively reviewed all cases in which patients underwent secondary head and neck reconstructive surgery after radiotherapy at the National Cancer Center Hospital East in Kashiwa, Japan, between January 1999 and December 2018.
Results: We identified 35 free flap transfers performed on patients who previously underwent head and neck reconstruction and radiotherapy, including 19 between 1999 and 2008, and 16 between 2009 and 2018. Reasons for the second head and neck reconstruction included recurrence (14 patients between 1999 and 2008, and 7 between 2009 and 2018) , development of new lesions (1 patient between 1999 and 2008, and 4 between 2009 and 2018) , and to cure osteoradionecrosis of the jaw (2 patients between 1999 and 2008, and 3 between 2009 and 2018) . Postoperative complications developed in 10 patients between 1999 and 2008, and in 11 between 2009 and 2018. Total flap failure developed in one patient during the second decade.
Conclusions: Over the two-decade study period, we observed a decrease in the incidence of recurrence, an increase in patients with new lesions, and an increase in cases involving osteoradionecrosis of the jaw. The number of postoperative complications did not change.
