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DOI: 10.1055/s-2004-815682
General Principles and Analysis of Defects in Head and Neck Reconstruction
Publication History
Publication Date:
23 January 2004 (online)
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ABSTRACT
The challenging task of reconstructing head and neck defects can be performed nowadays with good results and high success rates. This field has developed significantly with the introduction of microsurgical techniques, where in one stage complex composite defects can be reconstructed. An appreciation of the physiologic and morphologic loss occurring as a result of defect creation, appropriate preoperative planning, individualized assessment and care, and multidisciplinary cooperation all can aid in optimizing the final outcome. In this review article, these issues, as well as the effects of radiation therapy on the reconstructive plan, the appropriate choice of vessels during the reconstruction, and the use of multiple flaps and their indications, are discussed. Results achieved today are a testament to the advancements in the field of reconstructive microsurgery, where both functional and aesthetic goals are met.
KEYWORDS
Head and neck reconstruction - microsurgery - free tissue transfer
REFERENCES
- 1 Crile G. Excision of cancer of the head and neck with special reference to the plan of dissection based on one hundred and thirty-two operations. JAMA . 1906; 47 1780-1788
- 2 Byers R M. Modified neck dissection. A study of 967 cases from 1970 to 1980. Am J Surg . 1985; 150(4) 414-421
- 3 Bocca E, Pignataro O. A conservation technique in radical neck dissection. Ann Otol Rhinol Laryngol . 1967; 76(5) 975-987
- 4 Edgerton Jr T M. Replacement of lining to oral cavity following surgery. Cancer . 1951; 4 110
- 5 Bakamjian V Y. A two-stage method for pharyngoesophageal reconstruction with a primary pectoral skin flap. Plast Reconstr Surg . 1965; 36 173-184
- 6 Ariyan S. The pectoralis major myocutaneous flap. A versatile flap for reconstruction in the head and neck. Plast Reconstr Surg . 1979; 63(1) 73-81
- 7 Tansini I, Sopra I L. Mio Nuovo Processo Di Amputazione della mamella. Riforma Med . 1906; 12 757
- 8 Maxwell G P. Iginio Tansini and the origin of the latissimus dorsi musculocutaneous flap. Plast Reconstr Surg . 1980; 65(5) 686-692
- 9 Quillen C G, Shearin Jr C J, Georgiade N G. Use of the latissimus dorsi myocutaneous island flap for reconstruction in the head and neck area: case report. Plast Reconstr Surg . 1978; 62(1) 113-117
- 10 McCraw J B, Magee W P, Kalwaic H. Uses of the trapezius and sternomastoid myocutaneous flaps in head and neck reconstruction. Plast Reconstr Surg . 1979; 63(1) 49-57
- 11 Demergasso F, Piazza M V. Trapezius myocutaneous flap in reconstructive surgery for head and neck cancer: an original technique. Am J Surg . 1979; 138(4) 533-536
- 12 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
- 13 Panje W R, Bardach J, Krause C J. Reconstruction of the oral cavity with a free flap. Plast Reconstr Surg . 1976; 58(4) 415-418
- 14 Harashina T, Fujino T, Aoyagi F. Reconstruction of the oral cavity with a free flap. Plast Reconstr Surg . 1976; 58(4) 412-414
- 15 Daniel R K, Taylor G I. Distant transfer of an island flap by microvascular anastomoses. A clinical technique. Plast Reconstr Surg . 1973; 52(2) 111-117
- 16 Yang G, Chen B, Gao Y. et al . Forearm free skin flap transplantation. Nat Med J China . 1981; 61 139
- 17 Soutar D S, McGregor I A. The radial forearm flap in intraoral reconstruction: the experience of 60 consecutive cases. Plast Reconstr Surg . 1986; 78(1) 1-8
- 18 Taylor G I, Miller G D, Ham F J. The free vascularized bone graft. A clinical extension of microvascular techniques. Plast Reconstr Surg . 1975; 55(5) 533-544
- 19 Hidalgo D A. Fibula free flap: a new method of mandible reconstruction. Plast Reconstr Surg . 1989; 84(1) 71-79
- 20 Wei F C, Chen H C, Chuang C C, Noordhoff M S. Fibular osteoseptocutaneous flap: anatomic study and clinical application. Plast Reconstr Surg . 1986; 78(2) 191-200
- 21 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(5) 595-604
- 22 Soutar D S, Widdowson W P. Immediate reconstruction of the mandible using a vascularized segment of radius. Head Neck Surg . 1986; 8(4) 232-246
- 23 dos Santos F L. Retallro escapular: um novo retalbro livre microcirurgico. Rev Bras Cir . 1976; 70 133
- 24 Teot L, Bosse J P, Moufarrege R. et al . The scapular crest pedicled bone graft. Int J Microsurg . 1981; 3 257-262
- 25 Swartz W M, Banis J C, Newton E D, Ramasastry S S, Jones N F, Acland R. The osteocutaneous scapular flap for mandibular and maxillary reconstruction. Plast Reconstr Surg . 1986; 77(4) 530-545
- 26 O'Brien B M, Morrison W A, MacLeod A M, Dooley B J. Microvascular osteocutaneous transfer using the groin flap and iliac crest and the dorsalis pedis flap and second metatarsal. Br J Plast Surg . 1979; 32(3) 188-206
- 27 MacLeod A M, Robinson D W. Reconstruction of defects involving the mandible and floor of mouth by free osteo-cutaneous flaps derived from the foot. Br J Plast Surg . 1982; 35(3) 239-246
- 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(7) 2219-2226
- 29 Nakajima H, Fujino T, Adachi S. A new concept of vascular supply to the skin and classification of skin flaps according to their vascularization. Ann Plast Surg . 1986; 16(1) 1-19
- 30 Koshima I, Soeda S. Inferior epigastric artery skin flaps without rectus abdominis muscle. Br J Plast Surg . 1989; 42(6) 645-648
- 31 Koshima I, Moriguchi T, Soeda S, Kawata S, Ohta S, Ikeda A. The gluteal perforator-based flap for repair of sacral pressure sores. Plast Reconstr Surg . 1993; 91(4) 678-683
- 32 Angrigiani C, Grilli D, Siebert J. Latissimus dorsi musculocutaneous flap without muscle. Plast Reconstr Surg . 1995; 96(7) 1608-1614
- 33 Shieh S J, Chiu H Y, Yu J C, Pan S C, Tsai S T, Shen C L. Free anterolateral thigh flap for reconstruction of head and neck defects following cancer ablation. Plast Reconstr Surg . 2000; 105(7) 2349-2357
- 34 Chana J S, Chen H C, Sharma R, Hao S P, Tsai F C. Use of the free vastus lateralis flap in skull base reconstruction. Plast Reconstr Surg . 2003; 111(2) 568-574
- 35 Gedebou T M, Wei F C, Lin C H. Clinical experience of 1284 free anterolateral thigh flaps. Handchir Mikrochir Plast Chir . 2002; 34(4) 239-244
- 36 Koshima I. Free anterolateral thigh flap for reconstruction of head and neck defects following cancer ablation. Plast Reconstr Surg . 2000; 105(7) 2358-2360
- 37 Lutz B S, Wei F C. Microsurgical reconstruction of the buccal mucosa. Clin Plast Surg . 2001; 28(2) 339-347
- 38 McConnel F M, Pauloski B R, Logemann J A. et al . Functional results of primary closure vs flaps in oropharyngeal reconstruction: a prospective study of speech and swallowing. Arch Otolaryngol Head Neck Surg . 1998; 124(6) 625-630
- 39 Santamaria E, Wei F C, Chen I H, Chuang D C. Sensation recovery on innervated radial forearm flap for hemiglossectomy reconstruction by using different recipient nerves. Plast Reconstr Surg . 1999; 103(2) 450-457
- 40 Yousif N J, Dzwierzynski W W, Sanger J R, Matloub H S, Campbell B H. The innervated gracilis musculocutaneous flap for total tongue reconstruction. Plast Reconstr Surg . 1999; 104(4) 916-921
- 41 Chen H C, Tang Y B, Chang M H. Reconstruction of the voice after laryngectomy. Clin Plast Surg . 2001; 28(2) 389-402
- 42 Chang Y M, Coskunfirat O K, Wei F C, Tsai C Y, Lin S N. Maxillary reconstruction with fibula osteoseptocutaneous free flap and simultaneous insertion of osteointegrated dental implants (in press). Submitted to Plast Reconstr Surg.
- 43 Dropkin M J. Body image and quality of life after head and neck cancer surgery. Cancer Pract . 1999; 7(6) 309-313
- 44 Singh B, Cordeiro P G, Santamaria E, Shaha A R, Pfister D G, Shah J P. Factors associated with complications in microvascular reconstruction of head and neck defects. Plast Reconstr Surg . 1999; 103(2) 403-411
- 45 Shestak K C, Jones N F, Wu W, Johnson J T, Myers E N. Effect of advanced age and medical disease on the outcome of microvascular reconstruction for head and neck defects. Head Neck . 1992; 14(1) 14-18
- 46 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(7) 1234-1241
- 47 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(5) 425-428
- 48 Chick L R, Walton R L, Reus W, Colen L, Sasmor M. Free flaps in the elderly. Plast Reconstr Surg . 1992; 90(1) 87-94
- 49 Shaari C M, Buchbinder D, Costantino P D, Lawson W, Biller H F, Urken M L. Complications of microvascular head and neck surgery in the elderly. Arch Otolaryngol Head Neck Surg . 1998; 124(4) 407-411
- 50 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(5) 1154-1160
- 51 Baker D G. The radiobiological basis for tissue reactions in the oral cavity following therapeutic x-irradiation. Arch Otolaryngol . 1982; 108(1) 21-24
- 52 Gurtner G C, Evans G R. Advances in Head and Neck Reconstruction. Plast Reconstr Surg . 2000; 106(3) 672-682
- 53 Miller M J, Janjan N A. Treatment of injuries from radiation therapy. In: Kroll SS, ed. Reconstructive Plastic Surgery for Cancer 1st ed. St. Louis: Mosby 1996
- 54 Epstein J B, Emerton S, Kolbinson D A. et al . Quality of life and oral function following radiotherapy for head and neck cancer. Head Neck . 1999; 21(1) 1-11
- 55 Khouri R K, Cooley B C, Kunselman A R. et al . A prospective study of microvascular free-flap surgery and outcome. Plast Reconstr Surg . 1998; 102(3) 711-721
- 56 Johnson J T, Bloomer W D. Effect of prior radiotherapy on postsurgical wound infection. Head Neck . 1989; 11(2) 132-136
- 57 Deutsch M, Kroll S S, Ainsle N, Wang B. Influence of radiation on late complications in patients with free fibular flaps for mandibular reconstruction. Ann Plast Surg . 1999; 42(6) 662-664
- 58 Mantravadi R V, Skolnik E M, Applebaum E L. Complications of postoperative and preoperative radiation therapy in head and neck cancers. A comparative study. Arch Otolaryngol . 1981; 107(11) 690-693
- 59 Coleman III J J. Management of radiation-induced soft-tissue injury to the head and neck. Clin Plast Surg . 1993; 20(3) 491-505
- 60 Coleman III J J, Tan K C, Searles J M, Hester T R, Nahai F. Jejunal free autograft: analysis of complications and their resolution. Plast Reconstr Surg . 1989; 84(4) 589-595
- 61 Neovius E B, Lind M G, Lind F G. Hyperbaric oxygen therapy for wound complications after surgery in the irradiated head and neck: a review of the literature and a report of 15 consecutive patients. Head Neck . 1997; 19(4) 315-322
- 62 Mathes S J, Alexander J. Radiation injury. Surg Oncol Clin N Am . 1996; 5(4) 809-824
- 63 Neligan P C, She-Yue H, Gullane P J. Reverse flow as an option in microvascular recipient anastomoses. Plast Reconstr Surg . 1997; 100(7) 1780-1785
- 64 Chalian A A, Anderson T D, Weinstein G S, Weber R S. Internal jugular vein versus external jugular vein anastamosis: implications for successful free tissue transfer. Head Neck . 2001; 23(6) 475-478
- 65 Kubo T, Haramoto U, Yano K. et al . Internal jugular vein occlusion in head and neck microsurgical reconstruction. Ann Plast Surg . 2002; 49(5) 490-494
- 66 Miller M J, Schusterman M A, Reece G P, Kroll S S. Use of interposition vein grafts in head and neck microsurgery. J Reconstr Microsurg . 1994; 10(2) 133-134
- 67 Nakayama B, Kamei Y, Toriyama K, Hyodo I, Hasegawa Y, Torii S. Usefulness of a first transferred free flap vascular pedicle for secondary microvascular reconstruction in the head and neck. Plast Reconstr Surg . 2002; 109(4) 1246-1253
- 68 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(3) 319-323
- 69 Horng S Y, Chen M T. Reversed cephalic vein: a lifeboat in head and neck free-flap reconstruction. Plast Reconstr Surg . 1993; 92(4) 752-753
- 70 Topalan M, Bilgin-Karabulut A, Ermis I. “Extracorporeal loop” (blind loop): an alternative microsurgical technique for prelaminated flap transfer. J Reconstr Microsurg . 2002; 18(3) 155-158
- 71 Wei F C, Demirkan F, Chen H C, Chen I H, Liao C T, Hau S P. Management of secondary soft-tissue deficits following microsurgical head and neck reconstruction by means of another free flap. Plast Reconstr Surg . 1999; 103(4) 1158-1166
- 72 Wei F C, Celik N, Chen H C, Cheng M H, Huang W C. Combined anterolateral thigh flap and vascularized fibula osteoseptocutaneous flap in reconstruction of extensive composite mandibular defects. Plast Reconstr Surg . 2002; 109(1) 45-52
- 73 Miller M J, Evans G R. Multidisciplinary care in head and neck cancer. Clin Plast Surg . 2001; 28(2) 253-260