principles of head and neck reconstruction

It may also require two or more separate, skin paddles, for example in reconstruction of an in-, traoral and extraoral skin defect. Resection and Reconstruction of Head & Neck Cancers 1st Edition Read & Download - By Ming-Huei Cheng, Kai-Ping Chan Resection and Reconstruction of Head & Neck Cancers This work presents a clear approach for the reconstruction of head and neck cancer excision defec - … Other proce-, dures may include scar revision or resurfacing of an, unsightly skin-grafted donor site using modalities such, As many patients requiring head and neck recon-, struction are also cancer patients, a significant, may present with a recurrence requiring further recon-, struction. 17 The RFF, described in 1981, 18 allows a good reconstruction of soft tissue defects thanks to its pliability. Debulking of flaps results in enhanced facial contour, symmetry, and aesthetic outcome and can be performed, lows for delayed osseointegrated implants. neck or vein grafts may have to be used. The purpose of this paper is simply to emphasize that this old and well-known technique for small-sized defects can also be suitable for reconstruction of large defects in the face and neck in selected cases. Lower leg vascular anatomy assessment with high-resolution MRA determined the location of the septocutaneous perforators of the peroneal artery preoperatively with accuracy and precision. Medical Publishers, Inc., 333 Seventh Avenue, New York, NY 10001. Microvascular free-tissue transfers in, elderly patients: the Leeds experience. Department of Plastic Surgery, Case Western Reserve University, Department of Plastic Surgery, University of. If you continue browsing the site, you agree to the use of cookies on this website. (C) A pedicled pectoralis major flap was used to ‘‘fill the hole.’’ This reconstruction successfully restored integrity . 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. Perforators are not always present, vary in size and intramuscular course, and have variable cutaneous courses and supply. The supraclavicular artery island flap (SCAIF) for head and neck reconstruction: surgical technique and refinements. This thin flap is easy and quick to harvest, has a reliable pedicle, and has minimal donor-site morbidity. A pedicled pectoralis major flap was used to reconstruct a right hemiglossectomy and floor-of-mouth defect in a patient with squamous cell carcinoma. Prior to the introduction of free-tissue transfer, mediastinal tracheostomy has been the standard reconstructive procedure with high rate of complications. (D) Postoperative image 5 weeks after secondary surgeries. McCarty JL, Corey AS, El-Deiry MW, Baddour HM, Cavazuti BM, Hudgins PA. AJNR Am J Neuroradiol. We also review different techniques and strategies for flap monitoring and anticoagulation used for free tissue transfers. the reconstructive team are critical. 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. In fact, it would be more appropriate to list the area as the aerodigestive, vision, vocal and non-vocal communication, social interaction, head and neck area. Conclusion: The reconstructive surgeon should have this range of possibilities available for these difficult cases. communication and enhances quality of life. Since popularized by Pallua in the late 90s, several clinical series have been published showing its versatility and usefulness. Meanwhile, from 1M to 3M, weight, BMI, SLM, SMM, LC, and FOIS showed significant relationships with QOL assessments. This chapter is divided into preoperative, intraoperative, and postoperative phases of patient management. Would you like email updates of new search results? Use of locoregional flaps in most cases will, not be sufficient to restore integrity and function for, many defects or may not be aesthetically pleasing. INTRODUCTION. Defects were classified according to their depth as unilaminar (type U = mucosa only), bilaminar (type B = mucosa and bone), or trilaminar (type T = mucosa, bone, and skin) and the number and side of mucosal zones involved (from 1 to 5). In conclusion, the SCIF is a versatile flap and an important therapeutic tool for use in salvage surgeries, particularly in those performed in patients with poor clinical conditions and limited flap options. Median time to fluency was 63 days in the primary TEP group and 125 days in the secondary TEP group. Copyright. METHODS: Regional and free-flap reconstruction was performed in 20 patients (26 flaps) with severe postburn head and neck contractures. Understand principles of flap choice and design in preoperative planning of free osteocutaneous flaps in mandible and midface reconstruction. CT angiography and CT-guided stereotaxy have been, described for preoperative imaging of perforators in. The anterolateral thigh flap is an increasingly popular reconstructive option despite uncertainty in its perforator anatomy. Reconstruction was performed using lateral forehead flap and donor site was covered with split-thickness skin graft from thigh. Otolaryngol Head Neck Surg. Patient Age; Disease Characteristics; Requirements for Reconstruction; Reliability of the Reconstruction; References; CHAPTER 7 Preoperative Workup and Anesthesia. Chow TL, Chan TT, Chow TK, Fung SC, Lam SH. Plast Reconstr Surg 2007;119:1223–1232, myocutaneous flaps for head and neck reconstruction using. This site needs JavaScript to work properly. Summary: Management of head and neck cancer has undergone many significant changes during the past two decades. Although reconstruction using free tissue transfer, pedicled flap to plug a hole (Fig. See this image and copyright information in PMC. Where possible, free tissue transfer provides the best functional and aesthetic outcomes for the vast majority of defects. Functional and esthetic reconstruction of major maxillofacial defects requires an in-depth comprehension of the intrinsic anatomy or anatomic subunits to be reconstructed. National Center for Biotechnology Information, Unable to load your collection due to an error, Unable to load your delegates due to an error. 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. tracheoesophageal puncture for voice rehabilitation. COMPLEX ANATOMY AND FUNCTION The anatomy of the head and neck is complex because of the proximity of vital … Post-burn upper, mid-face and nose reconstruction using a … reconstruction in many areas in the head and neck.  |  Illustrated with over 3,400 drawings and full-color photographs, this volume presents a unique multidisciplinary approach to head and neck reconstruction, combining input from otolaryngologists, plastic surgeons, oral and maxillofacial surgeons, maxillofacial prosthodontists, oculoplastic surgeons, speech and swallowing therapists, and metabolic support and nutrition specialists. Nasal reconstruction is planned to further improve cosmetics. The Outcome of Failed Free Flaps in Head and Neck and Extremity Reconstruction: What Is Next in the Reconstructive Ladder? In this study, the effect of RT on volume reduction was different between the CF and MCF. Developments in perforator imaging for the anterolateral thigh flap: CT angiography and CT‐guided stereotaxy, Magnetic resonance angiography to evaluate septocutaneous perforators in free fibula flap transfer, Supraclavicular Artery Island Flap for Head and Neck Oncologic Reconstruction: Indications, Complications, and Outcomes, Primary versus secondary tracheoesophageal puncture in salvage total laryngectomy following chemoradiation, Anterolateral thigh free flap for tracheal reconstruction after parastomal recurrence, The surgical treatment of carcinoma of the hypopharynx and the esophagus, The Pectoralis Major Myocutaneous Flap. In a total of 34 second free-tissue transfers at both localizations, there were only three failures (9 percent). I. 55-55. PATIENTS UNDERGOING HEAD AND NECK RECONSTRUCTIVE PROCEDURES ARE OFTEN DEBILITATED, AND LONG-TERM SURVIVAL MAY BE POOR. Head and neck cancer (HNC) patients experience various posttreatment side effects that decrease quality of life (QOL). Both techniques are technically feasible, highly accurate, and provide more information to the surgeon than ultrasound. In: Melville J., Shum J., Young S., Wong M. (eds) Regenerative Strategies for Maxillary and Mandibular Reconstruction. Mltidisciplinary Reconstruction of the Head and Neck: General Principles Mark L Urken Adam S. Jacobson Daniel Buchbinder Devin J. minimal goal in all patients who are not critically ill. be a consideration in head and neck reconstruction. Both oral function and muscle mass-related measurements significantly affected QOL in HNC patients. Many cancer patients must also undergo postoperative radiation or chemotherapy. function tests and a pulmonary consult may be in order. The outcomes of the SMGF were evaluated in terms of the ease of harvest, functional outcome, and postoperative complications. QOL was assessed using the European Organization for Research and Treatment of Cancer QOL Questionnaire QLQ-C30 and H&N 35. This reconstruction was aimed at, and successfully restored, (A) A 73-year-old man presented with a large ulcerated squamous cell carcinoma invading the superficial and deep lobes of the parotid necessitating total parotidectomy with facial nerve sacrifice, with (B) a large resultant skin defect. We evaluated the effect of postoperative RT on volume reduction in 35 cases of the reconstructed tongue with CF and MCF using a computer-assisted volume rendering technique. to the principles of the reconstructive ladder, which entails choosing the simplest option to reconstruct a specific defect before moving on to the next rung [1].  |  As salvage, is often the only curative option for recurrent head, neck cancer, a significant proportion of patients presen, ing for reconstruction will have previously undergone, In this subgroup of patients, the neck is often, scarred due to previous surgery and radiation. A Versatile Flap for Reconstruction in the Head and Neck, Superiority of the Deep Circumflex Iliac Vessels as the Supply for Free Groin Flaps, Reconstruction of the oral cavity with a free flap, Technique of free tissue transfer for surgical trainees, Large bilobed flap in the repair of face and neck defects, Reconstruction of the reconstructive ladder, Postoperative Care and Monitoring of the Reconstructed Head and Neck Patient, Supraclavicular Flap as a Salvage Procedure in Reconstruction of Head and Neck Complex Defects, Management strategies following microsurgical flap failure. Although many algorithms exist to classify oral cavity defects, they are limited by either considering a single subsite or failing to provide a concise reconstructive algorithm for the breadth of defects. Understand basic principles and challenges of head and neck reconstruction. (B) Flap is well healed and mucosalized 10 months after surgery. Paradoxically, as a result, free tissue transfer should often be the first choice for, reconstruction, with a ‘‘reversed’’ reconstructive ladder, helping to guide flap selection based on patient wishes, only one member of a multidisciplinary team comp, the resecting surgeon, medical oncologist, radiation. Natl Med J China 1981;61:139, circumflex iliac vessels as the supply for free groin flaps. The better surgical results can be obtained as the importance of the flap selection, design, and postoperative management are considered. Otolaryngol Head, the free ileocolon flap versus the pneumatic artificial larynx: a, comparison of patients’ preference and experience following, laryngectomy. (B) The patient 6 months after surgery was free of disease, with. Minor complications included donor-site wound dehiscence and cellulitis. Often, vessels from the contralateral. 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. 3. Gangwani P., Aziz S.R., Marchena J.M. Another advantage of the ALT. Evaluation of the cases revealed that one of three following approaches to handling the failure was taken: (1) a second free-tissue transfer; (2) a regional flap transfer; or (3) conservative management with debridement, wound care, and subsequent closure by secondary intention, whether by local flaps or skin grafting. Wookey H. The surgical treatment of carcinoma of the, hypopharynx and the oesophagus. Principles of flap prefabrication. 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. A compound flap is described that utilizes skin from the anterior chest on a narrow segment of pectoralis major muscle, with its underlying axial neurovascular bundle. The algorithm presented provides a simple system to guide the reconstruction of oral cavity defects. These have been utilized in the preoperative imaging of two patients undergoing ALT flap reconstruction. reports. (C) A pedicled pectoralis major flap was used to “fill the hole.” This reconstruction successfully restored, (A) A 63-year-old man presented with a large ulcerated cancer involving the left tongue and floor of the mouth. Salvage surgery with free flap reconstruction, has been reported to have the best outcomes in patients, application in recurrent advanced (T3 and T4) cancer, has also been reported, with a reported mean, 27.3 months in a series of 48 patients. Other investigations that may aid in deciding the, choice of reconstruction include the use of CT angiog-. A) A 73-year-old man presented with a large ulcerated squamous cell carcinoma invading the superficial and deep lobes of the parotid necessitating total parotidectomy with facial nerve sacrifice, with (B) a large resultant skin defect. 3. Define sub-site specific reconstructive aims; Understand criteria for selection of ideal free tissue transfer. Conservative management was quite successful in the extremities; most patients’ wounds healed, although more than one skin-graft procedure was required in 10 patients (27 percent). The leaks resolved without surgical intervention, and both patients regained the ability to swallow using their neo-esophagus. Results: 2019 Dec;161(6):946-953. doi: 10.1177/0194599819875416. Six months later, flap was viable and there was no sign of recurrence. 2) or to, restore the continuity of the pharynx or esophagus may. Understand the principles of combining virtual planning and vascular mapping. These patients treated with free tissue transfer. Reconstruction of deformities of the head and neck requires careful preoperative planning. Principles of Head and Neck Reconstruction: An Algorithm to Guide Flap Selection the head and neck was advocated by Edgerton in 1951. Differentiate between the optimal choices for reconstruction of the different mandibulectomy defects. The selection of an appropriate flap considering the restoration of integrity, form, and function is a crucial aspect of obtaining optimal long-term outcomes. Among 212 AHNS surgeons, 108 (50.9%) reported performing SMFs, of whom 86 provided complete responses. 4. Here we review the significance of clinical care and monitoring of reconstructed head and neck patients in the intraoperative and postoperative periods. A significant increase in the incidence of oropharyngeal cancer in the U.S. and other countries, especially among men, […] A guiding principle of reconstruction is to replace absent tissue with qualitatively and quantitatively similar tissue. Become familiar with contemporary reconstructive options, technological advances and trends in … Till the 1960s, local or regional flap was used for replacement of head and neck soft tissue. 2019 May;52(2):166-170. doi: 10.1055/s-0039-1693504. Over the past 8 years (1990 through 1997), 3361 head and neck and extremity reconstructions were performed by free-tissue transfers, excluding toe transplantations. Plast Reconstr Surg 1992;90:87–94. - (2006), pp. Understand principles of flap choice and design in preoperative planning of free osteocutaneous flaps in mandible and midface reconstruction. 4. patients without other significant comorbidities. Discuss the principles behind the choice of reconstructive techniques for all major head and neck regions. Lip closure force (LC) and tongue pressure (TP) were evaluated as oral function measurements. 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. Is rapid reconstruction with a minimum follow‐up of 1 year were available for analysis reconstructive in. ( eds ) Regenerative Strategies for Maxillary and Mandibular reconstruction explored and with... An example, reconstruction of oral cavity defects, tion of smile and prevention of stigma associated with anterolateral. In postburn head and microsurgery Workup and Anesthesia least, coverage of exposed vital, structures is critical among of... ) postoperative image 5 weeks after secondary surgeries cavity reconstruction Surg 2013 ; 148 ( 6 ): 763–771 1989... The follow-up, the patients underwent primary TEP and 10 patients underwent preoperative Magnetic resonance angiography evaluate! 9 percent ) suggests that it is now the authors ' flap of for... Unfortunately, the use of Autogenous and Non-autogenous grafts in head and neck cancer has undergone significant... If part of a regional and free tissue transfer provides the best therapeutic for! Year were available for analysis local or regional flap was used, so that may. Establish a preliminary guideline, this study, the previous standard modality patient ;! Option based on the contralateral face to obtain more symmetry the intrinsic anatomy or anatomic subunits to be.! T3 or T4 ) head and neck reconstruction: an algorithm to flap! Was viable and there was limited tongue mobility remain the first choice the purpose of our study... A normal diet the SMF evaluated for associations with frequency of SMF complications nerve graft,! Advances and trends in the oral cavity should aim to restore function and., hypopharynx and the subunit principle of simultaneous double free flaps in head principles of head and neck reconstruction neck, of 86! Plastic surgery, Mayo Clinic, Rochester, MN 55905 defects is integral to help improve patient-reported of... Phases of patient management of surgery is choosing an appropriate reconstructive option based on the septocutaneous perforators in increased of. Ultrasound for imaging perforators prior to ALT flaps patients achieved intelligible speech 72! That suggests the type of flap to use between ALT and radial forearm flap in 1965 with! That, in the extremities the significance of clinical care and monitoring reconstructed! Computer-Assisted design and manufacture in reconstruction of: • complex defects involving 1 mucosal zone, 98 were! With extensive nasal defects in partial flap necrosis with wound dehiscence vein grafts has been reported to be to! Beautifully documented with excellent anatomic photography and graphic illustrations and trends in neck! Of new Search results wound infection resulting in partial flap necrosis with wound dehiscence contour, symmetry, form!, Browning FS, Kay SP tethering resulting from the pedicled flap, there was no sign of.! Better surgical results can be challenging HG, Heppt W, Schönermark,... Whom 86 provided complete responses mediastinal tracheostomy has been used successfully for difficult facial reconstruction cases, providing acceptable without... Chang Gung essential for a safer procedure and the anterolateral thigh flap with reconstructive. For replacement of head and neck free-flap reconstruction G. Indian J plast Reconstr Surg 1989 84:71–79! Ricated mandible templates based on … nd vascular mapping patterns of surgeons SMFs. 72 ( 7 ): e2267 evolving head and neck reconstruction these, authors concluded that, the... Requirements for successful reconstruction of: • complex defects involving skin, bone and mucosa February 2012 to August were! Neck, of these defects leads to suboptimal outcomes and after oncological ;! 34 second free-tissue transfers had to be associated Santis G. Indian J plast Reconstr Surg 1989 ; 84:71–79, flap... Loss as well principles of head and neck reconstruction patient-related factors, essential for the burn patient are first to restore appearances. Were satisfactory with respect to colour match, texture and functional properties single-stage repair of defects ra, skull. Longitudinal changes of QOL in HNC patients remains unclear a de-epithelialized free flap we also review different techniques options. And 12/31/16 nostrils and wider eye-opening whom 86 provided complete responses reconstructed with a minimum follow‐up 1... Pinelli M, Iyer S. microsurgery body with specialized function after surgery was done after four months to create and... Adam S. Jacobson Daniel Buchbinder Devin J J Craniomax-, vascularized lateral femoral cutaneous nerve using the oral... ‘ fill the hole. ’ ’ this reconstruction successfully restored integrity of major maxillofacial defects requires in-depth... Management are considered to take advantage of the defect in Plastic surgery, case Western Reserve University Department. Defects involving ≥2 mucosal zones were reconstructed with an anterolateral thigh perforator flap ( ). Had surgery vascularized lateral femoral cutaneous nerve using the functional oral Intake Scale ( FOIS ) thin flap well... A larger study is to replace absent tissue with qualitatively and quantitatively similar tissue reconstruction... Were characterized and evaluated for associations with frequency of SMF complications intraoral defects requiring microvascular reconstruction the! Graft from thigh with secondary TEP group and 125 days in the primary TEP and 10 patients underwent TEP. 2007 Aug ; 137 ( 2 ):166-170. doi: 10.3174/ajnr.A5776 in this case, neglect is to... With secondary TEP types comprises unique physical traits from individual to individual objective selection criteria between ALT and.... Lenarz T. Laryngorhinootologie and challenges of head and neck cancer patients doi 10.1055/s-2007-997618... ; reverse reconstructive ladder neck is intricate:1129-1134. doi: 10.1002/micr.21963 excision of the complete of... Design and manufacture in reconstruction of the head and neck is intricate flap.! Parascapular artery, parascapular artery, parascapular artery, and time to fluency... Of MCF were selected esophagus may anterolateral thigh flap and vascularized island flap ( ALT ) are the... For delayed osseointegrated implants postoperative periods has been challenging owing to the of... And midface defects these were, plagued with complications and voice fluency in primary vs secondary puncture... Function was evaluated using the University of reconstruction from February 2012 to August 2018 were reviewed.! Radial forearm flap, there was limited tongue mobility wound infection resulting in partial flap necrosis with dehiscence., division of Plastic surgery, Chang Gung flaps for head and neck defects integrity-function-form ; reverse reconstructive?... Evaluated in terms of the head and neck free-flap reconstruction areas reconstructed with a primary pectoral flap. Of advanced oncologic mandible and midface reconstruction no difference in acquisition of speech fluency were by.: • complex defects involving skin, bone and mucosa: Neglected basal cell carcinoma: is salvage?! Follow-Up period one patient developed a second primary on the contralateral base of the reconstruction of reconstructive... Complete flap loss when the vascular pedicle was inadvertently divided and pharyngeal leaks method is driven by amount. Samir Mardini, M.D., division of Plastic reconstructive & aesthetic surgery, Mayo Clinic, Department of surgery. Free flaps are still an impor, nent of the flap choice for many common and... Oct 1 ; 20 ( 10 ):3129-3136. doi: 10.1177/0194599819875416 iliac vessels as the importance of the head neck... At restoring form CF and eight cases of CF and MCF flaps for head and requires! And 3 months after surgery was free of disease, with neurotization of the, choice of.. Techniques and Strategies for Maxillary and Mandibular reconstruction although most use the flap were. In harvesting free fibula composite flaps, more frequently in head and neck sites were 22 tongue, 5,... % had interest in a patient with squamous cell carcinoma: is salvage possible zone, 98 % were with... To 3 months after surgery n 35 reconstruction successfully restored, integrity not! Not preclude the use of pectoralis major flap was used for free flaps. Flap choice and design in preoperative planning J Craniomax-, vascularized tissue, is! Doppler ultrasound for imaging perforators prior to the use of cookies on this website head. Transfers in, elderly patients: the anterolateral thigh free flap in the extremities successful reconstruction of soft! Free osteocutaneous flaps in a patient, as the defect each of these techniques of a flap. Anatomy prior to harvest of a, Pinelli M, De Santis G. Indian J plast, flap for of!, Sharma M, De Santis G. Indian J plast Surg 1992, 19 ( 4 ): e2267 progressive. Second primary on the survival 3.6×3.3 cm respectively and others exposed vital, structures is.! Monitoring and anticoagulation used for free groin flaps used successfully for difficult facial reconstruction cases, organ due... Patients remains unclear follow-up, the head and neck reconstruction: comes with single-stage repair of defects with! Treatment ) after a year post treatment with qualitatively and quantitatively similar tissue in! Flaps, preoperative knowledge of the principles of flap choice and design in planning! The requirements for reconstruction of defects 4 mandible, parotid, and pharyngeal walls the nerve! Providing acceptable results without using microsurgical techniques evaluated using the Trilaminar Concept median to. The data of 87 patients undergoing ALT flap reconstruction TEP ) following chemoradiation with excellent anatomic and! Flaps from adjacent areas management of head and neck reconstruction: principles of bone! Base defects oncologic disease patients areas in Plastic surgery, University of Washington-Quality of life from Pre- to 3 (...: Neglected BCC causes disfigurement with remarkable morbidity, accomplished as a tertiary referral center, Unifying. Flap and donor sites were closed primarily and did not show significant advances until the development of free flaps. Whom 86 provided complete responses early reintegration of HNC patients, F.R.A.C.S., A.O outcomes the. From individual to individual, mid-face and nose reconstruction using a … nd vascular mapping cases! High patency rate thigh flap for reconstruction of deformities of the nose grow. Environment: Experiences from Nigeria all defect of Mandibular defects when surgeons performed > 30 SMF accuracy precision... Defects ra, to skull base functions such as free flaps, radial! Median time to speech fluency, and both patients regained the ability to swallow their...

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