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DOI: 10.1055/s-0030-1255332
Principles of Head and Neck Reconstruction: An Algorithm to Guide Flap Selection
Publication History
Publication Date:
21 June 2010 (online)
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ABSTRACT
Advances in head and neck reconstruction have resulted in improved outcomes with single-stage repair of defects ranging from intraoral to pharyngoesophageal to skull base defects. Key to success of surgery is choosing an appropriate reconstructive option based on the patient's wishes and fitness for major surgery. Where possible, free tissue transfer provides the best functional and aesthetic outcomes for the vast majority of defects. In this article, we present an algorithm to guide choice of flap selection and review principles of reconstruction and secondary surgery for head and neck defects.
KEYWORDS
Flap selection - free tissue transfer - integrity-function-form - reverse reconstructive ladder
REFERENCES
- 1 Emerick K S, Tomycz L, Bradford C R et al.. Primary versus secondary tracheoesophageal puncture in salvage total laryngectomy following chemoradiation. Otolaryngol Head Neck Surg. 2009; 140 386-390
- 2 Chen H C, Mardini S, Yang C W. Voice reconstruction using the free ileocolon flap versus the pneumatic artificial larynx: a comparison of patients' preference and experience following laryngectomy. J Plast Reconstr Aesthet Surg. 2006; 59 1269-1275
- 3 Cordeiro P G, Bacilious N, Schantz S, Spiro R. The radial forearm osteocutaneous “sandwich” free flap for reconstruction of the bilateral subtotal maxillectomy defect. Ann Plast Surg. 1998; 40 397-402
- 4 Biglioli F, Autelitano L. Reconstruction after total parotidectomy using a de-epithelialized free flap. J Craniomaxillofac Surg. 2007; 35 364-368
- 5 Iida T, Nakagawa M, Asano T, Fukushima C, Tachi K. Free vascularized lateral femoral cutaneous nerve graft with anterolateral thigh flap for reconstruction of facial nerve defects. J Reconstr Microsurg. 2006; 22 343-348
- 6 Menick F J. Artistry in aesthetic surgery. Aesthetic perception and the subunit principle. Clin Plast Surg. 1987; 14 723-735
- 7 Burget G C, Menick F J. The subunit principle in nasal reconstruction. Plast Reconstr Surg. 1985; 76 239-247
- 8 Bridger A G, O'Brien C J, Lee K K. Advanced patient age should not preclude the use of free-flap reconstruction for head and neck cancer. Am J Surg. 1994; 168 425-428
- 9 Malata C M, Cooter R D, Batchelor A G, Simpson K H, Browning F S, Kay S P. Microvascular free-tissue transfers in elderly patients: the Leeds experience. Plast Reconstr Surg. 1996; 98 1234-1241
- 10 Chick L R, Walton R L, Reus W, Colen L, Sasmor M. Free flaps in the elderly. Plast Reconstr Surg. 1992; 90 87-94
- 11 Karanas Y L, Antony A, Rubin G, Chang J. Preoperative CT angiography for free fibula transfer. Microsurgery. 2004; 24 125-127
- 12 Fukaya E, Saloner D, Leon P, Wintermark M, Grossman R F, Nozaki M. Magnetic resonance angiography to evaluate septocutaneous perforators in free fibula flap transfer. J Plast Reconstr Aesth Surg. 2009; , July 4 (Epub ahead of print)
- 13 Rozen W M, Ashton M W, Stella D L et al.. Developments in perforator imaging for the anterolateral thigh flap: CT angiography and CT-guided stereotaxy. Microsurgery. 2008; 28 227-232
- 14 Hidalgo D A. Aesthetic improvements in free-flap mandible reconstruction. Plast Reconstr Surg. 1991; 88 574-585; discussion 586–587
- 15 Kroll S S, Evans G R, Goldberg D et al.. A comparison of resource costs for head and neck reconstruction with free and pectoralis major flaps. Plast Reconstr Surg. 1997; 99 1282-1286
- 16 Wookey H. The surgical treatment of carcinoma of the hypopharynx and the oesophagus. Br J Surg. 1948; 35 249-266
- 17 Edgerton Jr M T. Replacement of lining to oral cavity following surgery. Cancer. 1951; 4 110-119
- 18 Bakamjian V Y. A two-stage method for pharyngoesophageal reconstruction with a primary pectoral skin flap. Plast Reconstr Surg. 1965; 36 173-184
- 19 Ariyan S. The pectoralis major myocutaneous flap. A versatile flap for reconstruction in the head and neck. Plast Reconstr Surg. 1979; 63 73-81
- 20 Theogaraj S D, Merritt W H, Acharya G, Cohen I K. The pectoralis major musculocutaneous island flap in single-stage reconstruction of the pharyngoesophageal region. Plast Reconstr Surg. 1980; 65 267-276
- 21 Seidenberg B, Rosenak S S, Hurwitt E S, Som M L. Immediate reconstruction of the cervical esophagus by a revascularized isolated jejunal segment. Ann Surg. 1959; 149 162-171
- 22 Panje W R, Bardach J, Krause C J. Reconstruction of the oral cavity with a free flap. Plast Reconstr Surg. 1976; 58 415-418
- 23 Harashina T, Fujino T, Aoyagi F. Reconstruction of the oral cavity with a free flap. Plast Reconstr Surg. 1976; 58 412-414
- 24 Yang G, Chen B, Gao Y et al.. Forearm free skin flap transplantation. Natl Med J China. 1981; 61 139
- 25 Taylor G I, Townsend P, Corlett R. Superiority of the deep circumflex iliac vessels as the supply for free groin flaps. Plast Reconstr Surg. 1979; 64 595-604
- 26 Hidalgo D A. Fibula free flap: a new method of mandible reconstruction. Plast Reconstr Surg. 1989; 84 71-79
- 27 Song Y G, Chen G Z, Song Y L. The free thigh flap: a new free flap concept based on the septocutaneous artery. Br J Plast Surg. 1984; 37 149-159
- 28 Wei F C, Jain V, Celik N, Chen H C, Chuang D C, Lin C H. Have we found an ideal soft-tissue flap? An experience with 672 anterolateral thigh flaps. Plast Reconstr Surg. 2002; 109 2219-2226; discussion 2227–2230
- 29 Lin Y T, Lin C H, Wei F C. More degrees of freedom by using chimeric concept in the applications of anterolateral thigh flap. J Plast Reconstr Aesthet Surg. 2006; 59 622-627
- 30 Koshima I, Yamamoto H, Hosoda M, Moriguchi T, Orita Y, Nagayama H. Free combined composite flaps using the lateral circumflex femoral system for repair of massive defects of the head and neck regions: an introduction to the chimeric flap principle. Plast Reconstr Surg. 1993; 92 411-420
- 31 Koshima I, Hosoda S, Inagawa K, Urushibara K, Moriguchi T. Free combined anterolateral thigh flap and vascularized fibula for wide, through-and-through oromandibular defects. J Reconstr Microsurg. 1998; 14 529-534
- 32 Chiu E S, Liu P H, Friedlander P L. Supraclavicular artery island flap for head and neck oncologic reconstruction: indications, complications, and outcomes. Plast Reconstr Surg. 2009; 124 115-123
- 33 Chow T L, Chan T T, Chow T K, Fung S C, Lam S H. Reconstruction with submental flap for aggressive orofacial cancer. Plast Reconstr Surg. 2007; 120 431-436
- 34 Wei F C, Demirkan F, Chen H C et al.. The outcome of failed free flaps in head and neck and extremity reconstruction: what is next in the reconstructive ladder?. Plast Reconstr Surg. 2001; 108 1154-1160; discussion 1161–1162
- 35 Okazaki M, Asato H, Takushima A et al.. Analysis of salvage treatments following the failure of free flap transfer caused by vascular thrombosis in reconstruction for head and neck cancer. Plast Reconstr Surg. 2007; 119 1223-1232
- 36 Tan N C, Cigna E, Varkey P, Liu Y T. Debulking of free myocutaneous flaps for head and neck reconstruction using an arthroscopic shaver. Int J Oral Maxillofac Surg. 2007; 36 450-452
- 37 Kim A J, Suh J D, Sercarz J A et al.. Salvage surgery with free flap reconstruction: factors affecting outcome after treatment of recurrent head and neck squamous carcinoma. Laryngoscope. 2007; 117 1019-1023
- 38 Gleich L L, Ryzenman J, Gluckman J L, Wilson K M, Barrett W L, Redmond K P. Recurrent advanced (T3 or T4) head and neck squamous cell carcinoma: is salvage possible?. Arch Otolaryngol Head Neck Surg. 2004; 130 35-38
- 39 Miller M J, Schusterman M A, Reece G P, Kroll S S. Use of interposition vein grafts in head and microsurgery. J Reconstr Microsurg. 1994; 10 133-134
- 40 Yu P. The transverse cervical vessels as recipient vessels for previously treated head and neck cancer patients. Plast Reconstr Surg. 2005; 115 1253-1258
- 41 Harris J R, Lueg E, Genden E, Urken M L. The thoracoacromial/cephalic vascular system for microvascular anastomoses in the vessel-depleted neck. Arch Otolaryngol Head Neck Surg. 2002; 128 319-323
- 42 Horng S Y, Chen M T. Reversed cephalic vein: a lifeboat in head and neck free-flap reconstruction. Plast Reconstr Surg. 1993; 92 752-753
- 43 Caliceti U, Piccin O, Cavicchi O, Contedini F, Cipriani R. Anterolateral thigh free flap for tracheal reconstruction after parastomal recurrence. Head Neck. 2009; 31 1107-1111
- 44 Mardini S, Wei F C, Salgado C J, Chen H C. Reconstruction of the reconstructive ladder. Plast Reconstr Surg. 2005; 115 2174
Samir MardiniM.D.
Division of Plastic Surgery
Mayo Clinic, Rochester, MN 55905
Email: mardinis@aol.com