INDICATIONS OF VARIOUS FREE AND PEDICLED FLAPS IN HEAD AND NECK RECONSTRUCTION

Since the microvascular tissue transfer has been introduced in the rec onstructive surgery of the head and neck the question arises repeatedl y which free transplant should be favoured and which advantages exist to pedicled flaps. Based on our experiences in 243 reconstructions we discuss the advantages and disadvantages of different operative techni ques and their differential indications. Using free as well as pedicle d flaps, reconstructions can be performed individually and the decisio n for a transplant depends on localisation, size and depth of the defe ct. In contrast to conventional techniques, like the deltopectoral fla p, which we performed a decade ago, both new principles allow a one-st age procedure, which reduces the period of hospitalisation and improve s the quality of life for the patients. The advantages of free tissue transfer can be seen especially in the reconstruction of the upper dig estive tract after laryngopharyngectomy. The existing form of the jeju num segment like a tube allows an easy one-stage reconstruction, as we ll as better functional and aesthetic results. The radial forearm flap is a nearly ideal transplant in the anterior oral cavity because of t he mechanical stability. In contrast the jejunum patch is more vulnera ble and less qualified especially when fitting a prosthesis. In the po sterior oral cavity we prefer the jejunum patch because it allows more mobility of the tongue. Deep defects, for instance after glossectomy, should be reconstructed with a free latissimus-dorsi-flap or a pedicl ed myocutaneous pectoralis major flap. In contrast to free tissue tran sfer, pedicled flaps have the advantage that the difficult technique o f microanastomosis is avoided, which reduces the complication rate and the operation time. In our opinion the main indications for pedicled flaps concern secondary reconstructions after irradiation and/ or surg ery.