Abstract
In head and neck reconstructive procedure, the type of reconstruction selected should be tailored to the defect in order to achieve an optimal functional and aesthetic result. It is important to choose a reconstructive strategy that not only is tailored to the defect but also the patient. We know that a large proportion of patients presenting with head and neck cancer are the elderly with multiple co-morbidities, and therefore the decision-making process with regard to flap selection must take these patient-related factors into account, in order to minimize morbidity. Preoperative planning in the reconstruction of head and neck defects could be based on an emphasis on tumour-related and patient-related factors and how these can help us select the most appropriate reconstructive option for our patients.
-
1.
Tumour-related factors relating to the site and stage of the primary tumour guide the surgeon in the initial preoperative planning of the likely reconstruction required.
-
2.
Systemic and local patient-related factors such as relevant co-morbidities and previous radiotherapy must be considered at the planning stage in order to minimize preoperative risk and ensure that the most suitable reconstruction is selected.
-
3.
Defect analysis allows the surgeon to classify the post-resection deficit into simple, complex or composite defects, which can then be reconstructed based upon the required tissue components.
-
4.
By using the workhorse flap options such as anterolateral thigh flap, fibula osteocutaneous flap and radial forearm flap, most defects of the head and neck can be reconstructed, achieving favourable functional and aesthetic outcomes.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
References
Hurvitz KA, Kobayashi M, Evans GR. Current options in head and neck reconstruction. Plast Reconstr Surg. 2006;118:122e–33e.
Vos JD, Burkey BB. Functional outcomes after free flap reconstruction of the upper aerodigestive tract. Curr Opin Otolaryngol Head Neck Surg. 2004;12:305–10.
Sinha UK, Young P, Hurvitz K, Crockett DM. Functional outcomes following palatal reconstruction with a folded radial forearm free flap. Ear Nose Throat J. 2004;83:45–8.
Makitie AA, Beasley NJ, Neligan PC, Lipa J, Gullane PJ, Gilbert RW. Head and neck reconstruction with anterolateral thigh flap. Otolaryngol Head Neck Surg. 2003;129:547–55.
Chicarilli ZN. Sliding posterior tongue flap. Plast Reconstr Surg. 1987;79:697–700.
Chana JS, Wei F-C. A review of the advantages of the anterolateral thigh flap in head and neck reconstruction. Br J Plast Surg. 2004;57:603–9.
Yu P, Robb GL. Pharyngoesophageal reconstruction with the anterolateral thigh flap: a clinical and functional outcomes study. Plast Reconstr Surg. 2005;116:1845–55.
Vavares MA, Cheney ML, Gilklich RE, et al. Use of radial forearm fasciocutaneous free flap and montgomery salivary bypass tube for pharyngo-oesophageal reconstruction. Head Neck. 2000;22:463–8.
Reece GP, Bengtson BP, Schusterman MA. Reconstruction of the pharynx and cervical oesophagus using free jejunal transfer. Clin Plast Surg. 1994;21:125–47.
Boyd JB, Mulholland RS, Davidson J, et al. The free flap and plate in oromandibular reconstruction: long-term review and indications. Plast Reconstr Surg. 1995;95:1018–28.
Deschler DG, Hayden RE. The optimum method for reconstruction of complex lateral oromandibular-cutaneous defects. Head Neck. 2000;22:674–9.
Wei F-C, Celik N, Yang W-G, Chen I-H, Chang Y-M, Chen H-C. Complications after reconstruction by plate and soft-tissue free flap in composite mandibular defects and secondary salvage reconstruction with osteocutaneous flap. Plast Reconstr Surg. 2003;112:37–42.
Hanasono MM, Zevallos JP, Skoracki RJ, Yu P. A prospective analysis of bony versus soft-tissue reconstruction for posterior mandibular defects. Plast Reconstr Surg. 2010;125:1413–21.
Schusterman MA, Reece GP, Miller MJ. Osseous free flaps for orbit and midface reconstruction. Am J Surg. 1993;166:341–5.
Muzaffar AR, Adams WP Jr, Hartog JM, Rohrich RJ, Byrd HS. Maxillary reconstruction: functional and aesthetic considerations. Plast Reconstr Surg. 1999;104:2172–83.
Cordeiro PG, Santamaria E, Kraus DH, Strong EW, Shah JP. Reconstruction of total maxillectomy defects with preservation of the orbital contents. Plast Reconstr Surg. 1998;102:1874–87.
Neligan PC, Mulholland S, Irish J, et al. Flap selection in cranial base reconstruction. Plast Reconstr Surg. 1996;98:1159–68.
Edge SB, Byrd DR, Compton CC, Fritz AG, Greene FL, Trotti A, editors. AJCC cancer staging manual. 7th ed. New York: Springer; 2010.
Paleri V, Wight RG, Silver CE, Haigentz M Jr, Takes RP, Bradley PJ, et al. Comorbidity in head and neck cancer: a critical appraisal and recommendations for practice. Oral Oncol. 2010;46:712–9.
Singh B, Bhaya M, Zimbler M, Stern J, Roland JT, Rosenfeld RM, et al. Impact of comorbidity on outcome of young patients with head and neck squamous cell carcinoma. Head Neck. 1998;20:1–7.
Castro MA, Dedivitis RA, Ribeiro KC. Comorbidity measurement in patients with laryngeal squamous cell carcinoma. ORL J Otorhinolaryngol Relat Spec. 2007;69:146–52.
Sanabria A, Carvalho AL, Vartanian JG, Magrin J, Ikeda MK, Kowalski LP. Comorbidity is a prognostic factor in elderly patients with head and neck cancer. Ann Surg Oncol. 2007;14:1449–57.
Marshall WH, Fahey PJ. Operative complications and mortality in patients over 80 years of age. Arch Surg. 1964;88:896–904.
Serletti JM, Higgins JP, Moran S, et al. Factors affecting outcome in free-tissue transfer in the elderly. Plast Reconstr Surg. 2000;106:66–70.
Howard MA, Cordeiro PG, Disa J, et al. Free tissue transfer in the elderly: incidence of perioperative complications following microsurgical reconstruction in 197 septuagenerians and octogenarians. Plast Reconstr Surg. 2005;116:1659–68.
Stephen CR. Risk factors and outcome in elderly patients: an epidemiological study. In: Stephens CR, Assat RAE, editors. Geriatric anaesthesia: principles and practice. Boston: Butterworth; 1986.
Muravchik S. Anesthesia for the elderly. In: Miller RD, editor. Anesthesia. 5th ed. Philadelphia: Churchill Livingstone; 2000. p. 2140–56.
Bridger AG, O’Brien CJ, Lee KK. Advanced patient age should not preclude the use of free flap reconstruction in head and neck cancer. Am J Surg. 1994;168:425–8.
Chick LR, Walton RL, Reus W, et al. Free flaps in the elderly. Plast Reconstr Surg. 1992;90:87–94.
Beausang ES, Ang EE, Lipa JE, et al. Microvascular free tissue transfer in elderly patients: the Toronto experience. Head Neck. 2003;25:549–53.
Kuo YR, Jeng SF, Lin KM, Hou SJ, Su CY, Chien CY, et al. Microsurgical tissue transfers for head and neck reconstruction in patients with alcohol-induced mental disorder. Ann Surg Oncol. 2008;15:371–7.
Shih HS, Hsieh CH, Feng GM, Feng WJ, Jeng SF. An alternative option to overcome difficult venous return in head and neck free flap reconstruction. J Plast Reconstr Aesthet Surg. 2013;66:1243–7.
Ugurlu K, Ozcelik D, Huthut I, Yildiz K, Kilinc L, Bas L. Extended vertical trapezius myocutaneous flap in head and neck reconstruction as a salvage procedure. Plast Reconstr Surg. 2004;114:339–50.
Rosen HM. The extended trapezius musculocutaneous flap for cranio-orbital facial reconstruction. Plast Reconstr Surg. 1985;75:318–27.
Angrigiani C, Grilli D, Karanas YL, et al. The dorsal scapular island flap: an alternative for head, neck and chest reconstruction. Plast Reconst Surg. 2003;111:67–78.
Haas F, Weiglein A, Schwarzl F, et al. The lower trapezius musculocutaneous flap from pedicled to free flap: anatomical basis and clinical applications based on the dorsal scapular artery. Plast Reconst Surg. 2004;113:1580–90.
Liang CC, Jeng SF, Yang JC, Chen YC, Hsieh CH. Use of anteromedial thigh flaps as an alternative to anterolateral thigh flaps for reconstruction of head and neck defects in cancer patients. Ann Plast Surg. 2013;71:375–9.
Jeng SF, Tan NC. Optimizing aesthetic and functional outcomes at donor sites. Chang Gung Med J. 2012;35:219–30.
Warner MA, Offerd KP, Warner ME, et al. Role of preoperative cessation of smoking and other factors in postoperative pulmonary complications: a blinded prospective study of coronary bypass patients. Mayo Clin Proc. 1980;64:609–16.
Yamamoto K, Tsubokawa T, Shibata K, et al. Predicting difficult intubation with indirect laryngoscopy. Anesthesiology. 1997;86:316–21.
Hollenberg M, Mangano DT, Browner WS, et al. Predictors of postoperative myocardial ischaemia in patients undergoing non-cardiac surgery: the study of perioperative ischemia research. JAMA. 1992;268:205–9.
Fowkes FG, Lunn JN, Farrow SC, et al. Epidemiology in anesthesia. Mortality risk in patients with coexisting physical disease. Br J Anaesth. 1982;54:819–25.
Williams RL. Drug administration in hepatic disease. N Engl J Med. 1983;309:1616–22.
Reilly JJ. Does nutrition management benefit the head and neck patient? Oncology. 1990;4:105–15.
Williams EF, Meguid MM. Nutritional concepts and considerations in head and neck surgery. Head Neck. 1989;11:393–9.
Donald PJ. Complications of skull base surgery for malignancy. Laryngoscope. 1999;109:1959–66.
Disclosure
The authors have no financial interest to declare in relation to the content of this article.
Author information
Authors and Affiliations
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2019 The Author(s)
About this chapter
Cite this chapter
Sadigh, P.L., Jeng, SF. (2019). Preoperative Planning in the Reconstruction of Post-oncologic Head and Neck Defects. In: Cheng, MH., Chang, KP., Kao, HK. (eds) Resection and Reconstruction of Head & Neck Cancers. Head and Neck Cancer Clinics. Springer, Singapore. https://doi.org/10.1007/978-981-13-2444-4_4
Download citation
DOI: https://doi.org/10.1007/978-981-13-2444-4_4
Published:
Publisher Name: Springer, Singapore
Print ISBN: 978-981-13-2443-7
Online ISBN: 978-981-13-2444-4
eBook Packages: MedicineMedicine (R0)