OBJECTIVE: To determine the incidence and risk factors for the development of major wound complications in patients with squamous cell cancer of the head and neck that require surgical salvage after an initial treatment regimen of induction chemotherapy and definitive radiation therapy for organ preservation. DESIGN: Retrospective survey. SETTING: Academic tertiary care referral center. PATIENTS AND INTERVENTION: The medical records of 96 patients treated with induction chemotherapy followed by definitive radiation therapy were reviewed; 18 of these patients requiring a surgical salvage procedure after completing chemotherapy and radiation therapy and these constituted the study group. MAIN OUTCOME MEASURES: Major wound complications. RESULTS: Major wound complications occurred in 11 (61%) of the 18 patients. Surgical salvage within 1 year of initial treatment had a 77% incidence of major wound complications vs a 20% incidence if performed 1 year after initial treatment. The mean time to resolution of fistulae and flap necrosis was 7.7 months. Two deaths were attributed to major wound complications: one patient had a carotid blowout; one had postoperative pneumonia. CONCLUSIONS: Salvage surgical procedures performed after induction chemotherapy and definitive radiation therapy have a high rate of major wound complications. This should be considered when assessing organ preservation treatment strategies.