Safety and efficacy of suction-assisted lipectomy on irradiated skin and subcutaneous tissue

Reconstruction of soft tissue defects with standard myocutaneous or fasciocutaneous flaps often results in contour deformities due either to intrinsic characteristics of the flap or due to initial overcorrection of the defect when postoperative radiation therapy is planned. In such cases, revision with suction-assisted lipectomy is often necessary to achieve optimal cosmetic results. Since liposuction has been associated with decreased tissue perfusion, there remains significant concern that revision of irradiated flaps with liposuction places the patient at high risk for tissue necrosis and wound healing difficulty. To determine the safety of liposuction on irradiated tissue, the authors reviewed our experience of 9 patients treated for cancer with extirpation of tumor and immediate reconstruction with a free or pedicle flap. All patients required radiation therapy and ultimately underwent revision with liposuction due to contour irregularity. Flaps were treated with 60 to 64 Gy and between 30 and 300 mL of fat was removed at 6 weeks to 9 months after final dose of radiation therapy. All patients achieved improvement in contour with no significant fat or skin necrosis. We conclude that suction-assisted lipectomy of irradiated tissue is safe and effective for flap revision following conventional doses of radiation therapy.