A Systematic Review on the Impact of Adjuvant Radiochemotherapy on Free Flap Volume in Head and Neck Reconstruction

Abstract

Background: There is limited evidence regarding the effects of adjuvant radiochemotherapy on free flap volume in head and neck reconstruction, despite its importance as a predictor of both functional and patient-reported outcomes. Methods: Following PRISMA 2020 guidelines, this systematic review focused exclusively on full-text articles published in English between 2014 and 2024. Result: The study conducted a comprehensive review of over 1,000 publications sourced from reputable databases, including ScienceDirect, SagePub, and PubMed. Following an initial screening, five publications were identified as warranting more in-depth analysis. Consequently, a thorough review of these selected studies was performed to ensure a detailed and rigorous evaluation. Conclusion: Irradiated free flaps demonstrated a notable volume reduction (ranging from 5% to 15.5%) compared to non-irradiated flaps. This reduction has important implications for surgical planning in head and neck reconstructions, as flap volume directly impacts both functional and aesthetic outcomes. Clinicians should consider these findings when determining the surgical approach and reconstruction strategies. To better define the ideal flap volume for optimal outcomes, large-scale prospective studies with standardized protocols and well-defined follow-up assessments are necessary.