Combined Free Flap Reconstruction Following Head And Neck Cancer Resection: Chimeric And Double Free Flap Reconstruction

Background: Head and neck reconstruction following cancer resection remains a challenge for surgeons. Microsurgical free tissue transfer is the technique of choice to close the defect. Extensive complex defects resulted from radical excision often require two free flaps to provide adequate bony structure and soft tissue coverage. Method: Three cases following head and neck cancer resection that require reconstruction with two combined free flaps were reported. The combination of two free flaps between vastus lateral free flap, radial forearm free flap, and free fibular flap was reviewed in this study. The patients were then followed up for 1-2 months. Result: Two of the patients had a flow through chimeric free flap between radial forearm free flap and free fibular flap to reconstruct the maxillary, palatal and mandibular defect. One patient had a combination of free fibular flap and vastus lateral free flap to reconstruct the mandibular defect. No complications were observed in all patients. All the flaps were vital without donor site morbidity. However, two patients needed secondary procedures for further reconstructions. Conclusion: Combined free flaps are reliable for closing the complex defect after wide resection of head and neck cancer. They can provide adequate tissues, reduce recipient site morbidity, permit simultaneous reconstruction with two-team approach. Therefore, provide a practical method of defect coverage for these patients.

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Microvascular free flap reconstruction for head and neck cancer in a resource-constrained environment in rural India

Indian Journal of Plastic Surgery ◽

10.4103/0970-0358.113715 ◽

2013 ◽

Vol 46 (01) ◽

pp. 082-086 ◽

Cited By ~ 5

Author(s):

Nirav P. Trivedi ◽

Pravin Trivedi ◽

Harish Trivedi ◽

Saroj Trivedi ◽

Nirali Trivedi

Keyword(s):

Head And Neck Cancer ◽

Head And Neck ◽

Neck Cancer ◽

Free Flap ◽

Free Flaps ◽

Anterolateral Thigh Flap ◽

Rural India ◽

Resource Constrained ◽

Radial Forearm ◽

Anterior Mandible

ABSTRACT Introduction: Reconstruction with free flaps has significantly changed the outcome of patients with head and neck cancer. Microsurgery is still considered a specialised procedure and is not routinely performed in the resource-constrained environment of certain developing parts of India. Materials and Methods: This article focuses on the practice environment in a cancer clinic in rural India. Availability of infrastructure, selection of the case, choice of flap, estimation of cost and complications associated with treatment are evaluated and the merits and demerits of such an approach are discussed. Results: We performed 22 cases of free flaps in a six-month period (2008-2009). Majority (17) of the patients had oral cancer. Seven were related to the tongue and eight to the buccal mucosa. Radial forearm free flap (RFF: 9) and anterolateral thigh flap (ALT: 9) were the most commonly used flaps. A fibula flap (1) was done for an anterior mandible defect, whereas a jejunum free flap (1) was done for a laryngopharyngectomy defect. There were six complications with two re-explorations but no loss of flaps. Conclusion: Reconstruction with microvascular free flaps is feasible in a resource-constrained setup with motivation and careful planning.

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Maneuvers in Regional Flap Use in Reconstruction of Primary Defects in Head and Neck Cancer Patients: Presentation of Three Cases

International Journal of Head and Neck Surgery ◽

10.5005/jp-journals-10001-1181 ◽

2014 ◽

Vol 5 (1) ◽

pp. 48-55

Author(s):

Suha Nafea Aloosi

Keyword(s):

Head And Neck Cancer ◽

Head And Neck ◽

Cancer Patients ◽

Neck Cancer ◽

Free Flap ◽

Free Flaps ◽

Primary Defect ◽

Pedicled Flaps ◽

Submental Flap ◽

Regional Flap

ABSTRACT This case series highlights the advantages in the use of three regional flaps, submental flap, sternocleidomastoid flap and transverse cervical flap in maxillofacial primary defect reconstruction after ablative cancer surgery through presentation of three head and neck cancer patients in whom it was decided to do pedicled flaps rather than free flaps. Aim and objective This article is done in an attempt for encouraging for more introduction of these three flaps in head and neck reconstruction practice, and to encourage more studies be done to describe skin territory of cervical flap. Materials and methods Three patients presented to oral and maxillofacial department, diagnosed as having different kinds of cancer. All were managed according to the evidence-based guideline of head and neck cancer management, including the work up, diagnosis, TNM classification, surgical treatment, adjuvant treatment and follow-up. In all the three cases, regional flaps were used to close the primary defect. For the first patient, transverse cervical flap was used, the sternocleidomastoid flap in the second and submental flap in the third one. Results All flaps were easy to be harvested, in term of time and technique, and successful in term of viability, extension and in achieving the functional and cosmetic aim of reconstruction, with minimum donor site morbidity, all the patient are enjoying good quality of life. Conclusion and recommendations The regional flaps have their place to overcome limitation of free flaps due to the shortage in the armamentarium available in the hospital, especially in low resources regions, or limitations related to patients general condition, in addition, regional flaps are the best option available in case of failed free flap, or when free flap failure is anticipated and avoided. Highlighting the different maneuvers in harvesting and using regional pedicled flaps for further extensions widens the scope of indications and giving the reconstructive surgeon variability of options in reconstruction, obviates the need for special microvascular expertise in free flaps with comparable results and relatively less complication. How to cite this article Aloosi SN. Maneuvers in Regional Flap Use in Reconstruction of Primary Defects in Head and Neck Cancer Patients: Presentation of Three Cases. Int J Head Neck Surg 2014;5(1):48-55.

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Assessment of volume changes of radial forearm free flaps in head and neck cancer: Long-term results

Oral Oncology ◽

10.1016/j.oraloncology.2010.11.001 ◽

2011 ◽

Vol 47 (1) ◽

pp. 72-75 ◽

Cited By ~ 13

Author(s):

Young-Hoon Joo ◽

Se-Hwan Hwang ◽

Dong-Il Sun ◽

Jun-Ook Park ◽

Kwang-Jae Cho ◽

...

Keyword(s):

Head And Neck Cancer ◽

Head And Neck ◽

Neck Cancer ◽

Free Flaps ◽

Long Term Results ◽

Volume Changes ◽

Radial Forearm

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Reconstruction with free flaps in robotic head-and-neck onco-surgeries

Indian Journal of Plastic Surgery ◽

10.4103/ijps.ijps_35_18 ◽

2018 ◽

Vol 51 (03) ◽

pp. 283-289 ◽

Cited By ~ 1

Author(s):

Rajan Arora ◽

Vinay Kumar Verma ◽

Kripa Shanker Mishra ◽

Hemant Bhoye ◽

Rahul Kapoor

Keyword(s):

Head And Neck Cancer ◽

Head And Neck ◽

Neck Dissection ◽

Neck Cancer ◽

Free Flap ◽

Free Flaps ◽

Cancer Surgery ◽

Flap Reconstruction ◽

Free Flap Reconstruction ◽

Good Outcome

ABSTRACT Aims and Objective: The aim of the present article is to highlight how reconstruction with free flaps is different and difficult in cases with robotic head-and-neck cancer surgery. It also highlights the technical guidelines on how to manage the difficulties. Materials and Methods: Eleven patients with oropharyngeal cancer having undergone tumour excision followed by free-flap reconstruction been reviewed here. Nine patients had tumour excision done robotically through intraoral route while neck dissection done with transverse neck crease incision. There is a problem of difficult flap inset in this group of patient. Two patients had intraoral excision of tumour followed by robotic neck dissection via retroauricular incision. With no incision directly on the neck, microvascular anastomosis is challenging in this set of patients. Free flap was used in all the cases to reconstruct the defect. Results: Successful reconstruction with free flap was done in all the cases with good outcome both functionally and aesthetically. Conclusion: Free-flap reconstruction is possible in robotic head-and-neck cancer surgery despite small and difficult access, but it does need practice and some technical modifications for good outcome.

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O146. Comparative study of the anterolateral thigh flap versus the radial forearm free flap in head and neck cancer reconstruction

Oral Oncology Supplement ◽

10.1016/j.oos.2009.06.231 ◽

2009 ◽

Vol 3 (1) ◽

pp. 104-105

Author(s):

A. Marí ◽

C. Arranz ◽

S. Ramon

Keyword(s):

Head And Neck Cancer ◽

Comparative Study ◽

Head And Neck ◽

Neck Cancer ◽

Free Flap ◽

Anterolateral Thigh Flap ◽

Radial Forearm Free Flap ◽

Anterolateral Thigh ◽

Radial Forearm

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Radial forearm free flap in head and neck cancer treatment: may dermal substitutes have a role in minimizing the donor site morbidity?

European Journal of Plastic Surgery ◽

10.1007/s00238-019-01564-4 ◽

2019 ◽

Vol 43 (1) ◽

pp. 29-36

Author(s):

Mario Cherubino ◽

Anna Magni ◽

Mario Turri-Zanoni ◽

Leonardo Garutti ◽

Pietro di Summa ◽

...

Keyword(s):

Head And Neck Cancer ◽

Cancer Treatment ◽

Head And Neck ◽

Neck Cancer ◽

Free Flap ◽

Donor Site ◽

Donor Site Morbidity ◽

Radial Forearm Free Flap ◽

Dermal Substitutes ◽

Radial Forearm

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Long-Term Quality of Life in Survivors of Head and Neck Cancer Who Have had Defects Reconstructed With Radial Forearm Free Flaps

Journal of Craniofacial Surgery ◽

10.1097/scs.0000000000001280 ◽

2015 ◽

Vol 26 (2) ◽

pp. e75-e78 ◽

Cited By ~ 3

Author(s):

Peng Li ◽

Xu Zhang ◽

Rui-Hua Luo ◽

Ming Zhao ◽

Shan-Ting Liu ◽

...

Keyword(s):

Quality Of Life ◽

Head And Neck Cancer ◽

Head And Neck ◽

Neck Cancer ◽

Free Flaps ◽

Radial Forearm

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AN AUDIT ASSESSING RECORD KEEPING OF FREE FLAP OBSERVATIONS AFTER MAJOR HEAD AND NECK CANCER RESECTION AND RECONSTRUCTION SURGERY

10.26226/morressier.578e3b4dd462b80292381eab ◽

2016 ◽

Author(s):

Shafia Sabir

Keyword(s):

Head And Neck Cancer ◽

Head And Neck ◽

Neck Cancer ◽

Free Flap ◽

Cancer Resection ◽

Record Keeping ◽

Reconstruction Surgery

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Long-Term Outcomes after Double Free Flap Reconstruction for Locally Advanced Head and Neck Cancer

Journal of Reconstructive Microsurgery ◽

10.1055/s-0038-1667113 ◽

2018 ◽

Vol 35 (01) ◽

pp. 066-073 ◽

Cited By ~ 1

Author(s):

J. Brinkman ◽

Shoista Kambiz ◽

Tim de Jong ◽

Marc Mureau

Keyword(s):

Head And Neck Cancer ◽

Head And Neck ◽

Neck Cancer ◽

Free Flap ◽

Patient Survival ◽

Locally Advanced ◽

Free Flaps ◽

Advanced Head ◽

Patient Reported

Background The use of simultaneous, multiple free flaps has become a reliable reconstructive option in patients with extensive composite defects after resection of locally advanced head and neck cancer. However, some reluctance remains among reconstructive surgeons with concerns regarding flap outcomes and limited patient survival. Therefore, we evaluated complications, long-term patient survival, and patient-reported outcomes following these extensive head and neck reconstructions. Methods All consecutive patients treated with multiple free flaps for reconstruction of extensive composite defects after resection of locally advanced head and neck cancer between 1999 and 2014 were retrospectively reviewed. Patient charts were evaluated for demographics, treatment details, complications, and patient survival. In addition, all patients alive at the start of the study were asked to complete the 10-item Eat Assessment Tool (EAT-10) and the Intelligibility Rating Scale (IRS). Results Eighty-four simultaneous, multiple free flaps were performed in 42 patients. The predominant free flap combination consisted of a fibula with either an anterolateral thigh (n = 22) or a radial forearm flap (n = 14). Complete flap survival was 95%. Nineteen patients were still alive with a mean follow-up of 55 months. Five-year patient survival was 46.3%. Mean EAT-10 score was 8.4 (range: 0–29), with only one patient reporting problematic swallowing. Ninety percent of the patients had moderate to good speech intelligibility with the IRS. Conclusion Multiple, simultaneous free flaps can be performed safely, leading to acceptable long-term patient survival and patient-reported functional outcomes. Our study demonstrates that it is worthwhile to perform these challenging microvascular reconstructions in patients with locally advanced head and neck cancer.

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