The purpose of this study is to provide a comprehensive description of the spectrum of imaging characteristics and distribution of recurrent disease in patients with head and neck cancers reconstructed with flaps, which may allow salvage surgery and contribute to improved survival.

The majority of patients with recurrent disease following flap reconstruction developed their recurrence within the post-operative first eight months. Recurrent tumors typically present as infiltrating, enhancing masses which may have necrotic foci, and tend to occur along the flap margin and/or suture line. Approximately 38% of recurrences were not clinically suspected. Routine 3-month baseline imaging then further 3-month interval follow-up in the first year should be considered in patients with flap reconstruction for head and neck malignancy.