Outcomes in head and neck reconstruction by surgical site and donor site

Background Reconstruction after removal of a malignant tumor in the head and neck region is crucial for restoring tissue integrity, function, and aesthetics. We retrospectively analyzed patients who underwent intraoral reconstruction surgery using radial forearm free flaps (RFFF) and anterolateral thigh free flaps (ALT) at a single institution to provide more information supporting the choice of a reconstruction method after removal of head and neck cancer.Methods The charts of 708 patients who underwent head and neck reconstruction between 1998 and 2018 at the Department of Plastic and Reconstructive Surgery at our institution were retrospectively reviewed. Patients’ age, sex, and history of radiation therapy, diabetes mellitus, and smoking were retrieved. The primary cancer site, types of defects, and complications were investigated.Results Overall, 473 and 95 patients underwent reconstruction surgery with RFFF and ALT, respectively. RFFF was more often used in patients with cancers of the pharynx, larynx, esophagus, or tonsil, while ALT was more frequently used in patients with cancers of the mouth floor with tonsil or tongue involvement. The proportion of patients undergoing ALT increased gradually. Flap failure and donor site morbidities did not show significant differences between the two groups.Conclusions RFFF and ALT flaps resulted in similar outcomes in terms of flap survival and donor site morbidity. ALT can be an option for head and neck reconstruction surgery in patients with large and complex defects or for young patients who want to hide their donor site scars.

Download Full-text

Scapular Tip Free Flap in Composite Head and Neck Reconstruction

Otolaryngology ◽

10.1177/0194599818791783 ◽

2018 ◽

Vol 160 (1) ◽

pp. 57-62 ◽

Cited By ~ 4

Author(s):

Jeremiah C. Tracy ◽

Bryan Brandon ◽

Samip N. Patel

Keyword(s):

Head And Neck ◽

Free Flap ◽

Average Length ◽

Academic Medical Center ◽

Donor Site ◽

Case Series ◽

Head And Neck Reconstruction ◽

Bony Defect ◽

Neck Reconstruction ◽

Postoperative Hematoma

Objectives To describe the use of the scapular tip free flap (STFF) in the reconstruction of head and neck defects. Study Design Case series with chart review. Setting Academic medical center. Subjects and Methods A review of the electronic medical record was performed of all patients who underwent head and neck reconstructive surgery with STFFs from January 1, 2014, through January 1, 2016. Details regarding the disease, defect reconstructed, and surgical outcomes were quantified. Results Thirty-one consecutive cases were performed at our institution within the period reviewed. The procedures included reconstruction of 5 maxillectomy and 26 mandibulectomy defects. The mean length of mandible reconstructed was 6.8 cm (95% CI, 6.01-7.59; range, 4.0-10.2). Osteotomies were made to contour the scapular bone in 11 cases, including double osteotomies performed in 2 cases. The most common surgical complications were orocutaneous fistula and postoperative hematoma, which occurred in 3 (10%) and 2 (6.5%) of 31 patients, respectively. Conclusion This series describes a large number of STFFs performed in head and neck reconstruction. The average length of bony defect repair can be significantly larger than what was previously described. Performing osteotomies to the STFF allows for application to anterior mandibular defects. The STFF offers a large soft tissue component, a relatively long pedicle, and acceptable donor site morbidity. The STFF is a versatile reconstructive option that should be considered to address composite defects of the head and neck.

Download Full-text

‘Sit and tilt’ preparation for subscapular system free flaps

The Journal of Laryngology & Otology ◽

10.1017/s0022215117002511 ◽

2018 ◽

Vol 132 (2) ◽

pp. 180-183 ◽

Cited By ~ 1

Author(s):

J Mark ◽

H Patwa ◽

M S Costello ◽

Y Patil

Keyword(s):

Head And Neck ◽

Operative Time ◽

Donor Site ◽

Three Dimensional ◽

Free Tissue Transfer ◽

Free Flaps ◽

Head And Neck Reconstruction ◽

Advanced Head ◽

Neck Reconstruction ◽

Harvesting Technique

AbstractBackground:The ablation of advanced head and neck cancer often results in large three-dimensional defects that require free tissue transfer to optimally address functional and cosmetic issues. The subscapular system is a highly versatile donor site for flaps used for head and neck reconstruction. Traditional methods of harvesting subscapular flaps require repositioning and re-preparing, which significantly increases the operative time and prevents simultaneous harvesting of the flap.Method:This paper presents our experience of a single-stage ‘sit and tilt’ technique, which provides a convenient method for harvesting subscapular system free flaps without significant repositioning.Results and conclusion:This technique was used for a variety of head and neck defects, and body habitus did not seem to affect free tissue harvesting. It is hoped that utilisation of this preparation and harvesting technique will make head and neck surgeons more willing to take advantage of the subscapular system.

Download Full-text

Nerve Grafting in Head and Neck Reconstruction

Otolaryngology ◽

10.1016/s0194-5998(05)80116-0 ◽

1995 ◽

Vol 112 (5) ◽

pp. P57-P57

Author(s):

Brian B. Burkey ◽

William Armstrong

Keyword(s):

Head And Neck ◽

Donor Site ◽

Head And Neck Reconstruction ◽

Nerve Grafting ◽

Future Trends ◽

Nerve Reconstruction ◽

Neck Reconstruction ◽

Current Information ◽

Graft Donor ◽

Anastomotic Techniques

Educational objectives: To understand the most current information for all aspects of nerve reconstruction, including graft donor-site options, and graft harvesting and anastomotic techniques and to provide and update on future trends in nerve grafting.

Download Full-text

Medial Sural Artery Musculocutaneous Perforator (MSAP) Flap for Reconstruction of Pharyngoesophageal Defects

Otolaryngology ◽

10.1177/0194599820920829 ◽

2020 ◽

Vol 162 (6) ◽

pp. 993-995

Author(s):

Zahrah M. Taufique ◽

David A. Daar ◽

Jamie P. Levine ◽

Adam S. Jacobson

Keyword(s):

Lower Extremity ◽

Head And Neck ◽

Donor Site ◽

Head And Neck Reconstruction ◽

Neck Reconstruction ◽

Sural Artery ◽

Pharyngeal Reconstruction

We describe the use of the medial sural artery musculocutaneous perforator (MSAP) flap at our institution. It is a relatively new flap, originally described in 2001 for lower extremity defects, that has become increasingly popular for head and neck reconstruction due to its versatility, thinness, pliability, long pedicle, and particularly favorable donor site. It has been described for reconstruction of oral defects, but there is little published on its use in pharyngeal reconstruction. We suggest that the MSAP is an ideal flap for addressing defects caused by pharyngoesophageal stenosis, pharyngeal fistulas, or laryngopharyngectomies. We review 5 cases at our institution from June 2016 to November 2017.

Download Full-text