Reconstruction of massive defects in the head and neck: The role of simultaneous distant and regional flaps

TLDR

Advanced head and neck tumor resections can leave massive defects that cannot be reconstructed with a single tissue transfer technique. The study involved 16 patients who underwent simultaneous reconstruction with free flaps (radial forearm, iliac crest, parascapular/latissimus dorsi, rectus abdominis, fibula, lateral thigh) and pedicled regional flaps (pectoralis major, deltopectoral, cervical visor, paramedian forehead, cervicofacial, nape of neck). The combined approach successfully reconstructed defects involving aerodigestive mucosa and cutaneous skin, using free‑flap soft tissue for mucosa, bone for mandible, and regional flaps for facial and neck skin, demonstrating that simultaneous free and regional flaps are complementary when applied stepwise. © 1997 John Wiley & Sons, Inc., Head Neck 19: 620–628.

Abstract

Background Massive defects resulting from excision of advanced head and neck tumors may not be amenable to reconstruction using a single technique of tissue transfer. Sixteen patients undergoing reconstruction using simultaneous free flaps and pedicled regional flaps are presented. Methods Regional flaps included the pectoralis major, deltopectoral, cervical visor, paramedian forehead, cervicofacial, and nape of neck flaps. Microvascular tissue transfers included the radial forearm, iliac crest, parascapular/latissimus dorsi, rectus abdominis, fibula, and lateral thigh free flaps. Results Most defects involved both aerodigestive mucosa and external cutaneous skin. Mucosal reconstruction was carried out using the soft-tissue component of the free flaps, whereas vascularized bone was used for mandibular reconstruction. Regional flaps were used to reconstruct skin of the face and neck. Conclusions When planned and applied in a stepwise fashion, simultaneous free flaps and regional flaps are complimentary for the reconstruction of complex wounds in the head and neck. © 1997 John Wiley & Sons, Inc. Head Neck 19: 620–628, 1997.