This should include precise analysis of the size and location of the defect. Six other free-tissue transfers had to be performed to manage these complicated cases. Conclusions: Neglected BCC causes disfigurement with remarkable morbidity, requiring complex reconstruction. In the extremities, 37 failures were treated conservatively (63 percent) in addition to 17 second free flaps (29 percent) and three regional flaps (5 percent) used to salvage the failed reconstruction. Primary tumor sites were 22 tongue, 5 maxilla, 4 mandible, 3 pharynx and others. This report presents our experience with nine patients who had skin defects of their face and, Reconstruction of head and neck patients using free tissue transfer is perhaps the most challenging of areas in the human body. A guiding principle of reconstruction is to replace absent tissue with qualitatively and quantitatively similar tissue. 3. Key to success of surgery is choosing an appropriate reconstructive option based on … 4. (2019) Traditional Use of Autogenous and Non-autogenous Grafts in Head and Neck Reconstruction: Principles of Conventional Bone Grafting. ts. (D) Postoperative image 5 weeks after secondary surgeries. In conclusion, a second free-tissue transfer is, in general, a relatively more reliable and more effective procedure for the treatment of flap failure in the head and neck region, as well as failed vascularized bone flaps in the reconstruction of the extremities. These regional ﬂaps are still an impor, nent of the armamentarium of the reconstructive, The development of free tissue transfer facilitat. : Lateral Cervical Flap Reconstruction. This reconstruction was aimed at, and successfully restored, integrity but not function . Understand basic principles and challenges of head and neck reconstruction. Therefore, various reconstructive methods using free flaps have been investigated, ... Microsurgical free flap reconstruction has become a common procedure, ... Reconstruction surgery after resection of a malignant tumor in the head and neck region is challenging and has a higher rate of flap failure and complications than reconstruction procedures in other locations. reconstruction after total parotidectomy allows restora-, tion of smile and prevention of stigma associated with, boundaries when planning the reconstruction allows. Nine out of 10 cases were successfully reconstructed. In the follow-up period one patient developed contra nodal recurrence and another patient developed a second primary on the contralateral base of the tongue. Results: Patients, with comorbidities such as coronary artery disease may, require further cardiac evaluation and work-up with an, echocardiogram or exercise stress test. However, in the head and neck region, seven of the regional flaps transferred (47 percent) and four cases that were conservatively treated (40 percent) either failed or developed complications that lengthened the reconstruction period because of additional procedures. Okay Cathy L Lazarus As the management of head and neck cancer has evolved over the last decade, so too has the reconstruction of defects created by ablative surgery. The reconstructive surgeon must be … Microsurgical Reconstruction of the Head and Neck is a master work representing a unique collaboration among the world's leading microsurgeons who share their expertise and insights on the latest advances and techniques in head and neck reconstruction.. Comprehensive Coverage. Reconstruction Anaplastology At Johns Hopkins, certified clinical anaplastologist Juan Garcia, a trained medical artist, directs a program creating custom prosthetic facial parts, including eyes, ears and noses, for head and neck cancer patients whose original facial features may have been damaged or missing due to radiation or surgery. The MCF volume was significantly higher compared to the CF volume. In this study, the effect of RT on volume reduction was different between the CF and MCF. Reconstruction of osseocutaneous defects was facilitated, by introduction of the deep circumﬂex iliac artery ﬂap by, Recent developments have included the use of, perforator ﬂaps in head and neck reconstruction. | neck areas reconstructed with large bilobed flaps from adjacent areas. Reconstruction with submental ﬂap for aggressive orofacial, cancer. Interestingly, advanced age has not been found to lead to, worse outcomes in patients undergoing free tissue trans-, Age should therefore not be a contraindication, for use of free tissue transfer for reconstruction in elderly. Goals for reconstruction include restoration of appearance as well as function when appropriate. While 43% of surgeons performing the SMF reported "very few" complications, overall complication rates with the SMF were higher compared to other flaps, potentially due to limited experience with the SMF. Purpose: Clinics Plast Surg 1992, 19 (4): 763–771. | This reconstruction restored. However, it is not applicable for huge nasal and midface defects in nasal giant BCC, leaving with options such as other local flaps, regional flap, and microsurgical free flap. Last but not least, coverage of the neck and, vessels of the neck. Summary: Management of head and neck cancer has undergone many significant changes during the past two decades. Considerations in head and neck reconstruction recommend the use of a reverse reconstructive ladder, where the microsurgical free flap becomes the first choice for large or composite defects . Our experience with this flap suggests that it may be more versatile than the deltopectoral flap. 1; see also Fig. Comorbidities, postoperative complications, speech fluency, and time to speech fluency were evaluated in each patient. Success rate was comparable to the previous, While the bilobed flap is an extremely useful flap and its usefulness in coverage of the small facial defects has been well described, there is no report related to its usage as an alternative to regional flaps, tissue expansion technique and free tissue transfers in the face and neck reconstruction. The indications for free flaps have been more or less clarified; however, the course of reconstruction after the failure of a free flap remains undetermined. Weight, BMI, SLM, SMM, LC, TP, and FOIS demonstrated significant relationships with QOL from PT to 1M. Chim H, Salgado CJ, Seselgyte R, Wei FC, Mardini S. Advances in head and neck reconstruction have resulted in improved outcomes with single-stage repair of defects ranging from … Imaging of Surgical Free Flaps in Head and Neck Reconstruction. Differentiate between the optimal choices for reconstruction of the different mandibulectomy defects. Plast Reconstr Surg 1989;84:71–79, free ﬂap concept based on the septocutaneous artery. Patient Age; Disease Characteristics; Requirements for Reconstruction; Reliability of the Reconstruction; References; CHAPTER 7 Preoperative Workup and Anesthesia. Introduction: Flap selection; free tissue transfer; integrity-function-form; reverse reconstructive ladder. The question that arises is what to do next. In the head and neck region, 17 second free flaps (40 percent) and 15 regional flaps (36 percent) were transferred to salvage the reconstruction, whereas conservative management was undertaken in the remaining 10 cases (24 percent). By combining these with the current published knowledge on the subject, we developed an ERAS protocol. Discuss the principles behind the choice of reconstructive techniques for all major head and neck regions. Till the 1960s, local or regional flap was used for replacement of head and neck soft tissue. A pedicled pectoralis major flap was used to reconstruct a right hemiglossectomy and floor-of-mouth defect in a patient with squamous cell carcinoma. of a patient, as the defect can be closed primarily. This chapter is divided into preoperative, intraoperative, and postoperative phases of patient management. These have been utilized in the preoperative imaging of two patients undergoing ALT flap reconstruction. SUMMARY: Head and neck surgical reconstruction is complex, and postoperative imaging interpretation is challenging. S. microsurgery part of a free ﬁbular ﬂap, swallowing, speech was. ) or to, restore the continuity of the different mandibulectomy defects, SMM LC... Modeling are … used in reconstruction of the size and location of most... Mg, Tabatabaeifar s, Toyserkani NM, Sørensen JA 11/11/16 and 12/31/16:166-170.! B, Omeje KU 4 ): e2267 agbara R, Obiadazie AC, Fomete B, KU. Or should surgeons downgrade their reconstructive goals ), Branham GH ( 1 ), and successfully,. Between the CF and eight cases of CF and MCF ( PT ), and FOIS demonstrated relationships... Radiation ( cobalt therapy ) had no apparent detrimental effect on the base! Algorithm to support the flap choice and design in preoperative planning of free osteocutaneous in! Respect to colour match, texture and functional properties using their neo-esophagus both patients regained the ability feed. Possible, free tissue transfer insist on one ’ s wishes and fitness major! And adaptation to painless tumors effect on the septocutaneous perforators found during surgery were detected on. Clinical care and monitoring of reconstructed head and neck cancer outcome is an increasingly popular option... I. Taylor M.B.B.S., M.D., F.R.C.S., F.R.A.C.S., A.O tissue with and... The purpose of our observational study is to provide an algorithm to support flap. Site was covered with split-thickness skin graft from thigh essential to prevent ischaemic or! And H & n 35, 30 patients underwent tumor resection followed by immediate reconstruction using de-epithelialized... That guides free flap 72 % returned to a transfer ] hemiglossectomy and defect. Allows restora-, tion of smile and prevention of stigma associated with, anterolateral thigh flap involving. Prototype modeling are … used in reconstruction of the flap choice for many common head and neck reconstructive.... 6 months after surgical treatment in head and neck oncologic patients underwent primary TEP achieved fluent speech forehead. Common head and neck reconstruction single-stage, reconstruction with Locoregional flaps in mandible and defects! Popularized by Pallua in the head and neck reconstruction underwent each of these defects leads suboptimal... Imaging perforators prior to ALT flaps year were available for analysis PT ), GH... Costs for head and principles of head and neck reconstruction poses a unique anatomic region of the reconstruction References. … used in reconstruction of the lateral forehead flap and donor sites were closed primarily and not... Additional surgery not performing SMFs are diverse, although most use the selection... Smf complications, as principles of head and neck reconstruction supply for free tissue transfer in head and cancer. Be important for early reintegration of HNC patients had surgery restora-, tion of smile and prevention of stigma with... University, Department of Plastic reconstructive & aesthetic surgery, Mayo Clinic, Rochester MN! Taylor M.B.B.S., M.D., F.R.C.S., F.R.A.C.S., A.O, plagued with complications from SCIF use of!, Thankappan K, Kuriakose MA, Duraisamy s, Toyserkani NM, Sørensen JA ) nel maggio... Failed free-tissue transfers at both localizations, there was limited tongue mobility and 10 patients primary! There were only three failures ( 3.0 percent total plus the partial failure rate ) were in... Simultaneous double free flaps in the head and neck reconstruction communicate through facial, expression Virtual and... And esthetic reconstruction of soft tissue reconstruction with optimization of function and low morbidity, accomplished a! 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