RECONSTRUCTION OF MASSIVE DEFECTS IN THE HEAD AND NECK - THE ROLE OF SIMULTANEOUS DISTANT AND REGIONAL FLAPS

Background, Massive detects resulting from exci sion of advanced head and neck tumors may not be amenable to reconstruction using a single t echnique of tissue transfer, Sixteen patients undergoing reconstructio n using simultaneous free flaps and pedicled regional flaps are presen ted. Methods. Regional flaps included the pectoralis major, delto-pect oral, 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 ae rodigestive mucosa and external cutaneous skin. Mucosal reconstruction was carried out using the soft-tissue component of the free flaps, wh ereas vascularized bone was used for mandibular reconstruction. Region al flaps were used to reconstruct skin of the face and neck. Conclusio ns. When planned and applied in a stepwise fashion, simultaneous free flaps and regional flaps are complimentary for the reconstruction of c omplex wounds in the head and neck. (C) 1997 John Wiley & Sons, Inc.