COMBINED PEDICLED FLAPS FOR SIMULTANEOUS RECONSTRUCTION OF TONGUE, FLOOR OF THE MOUTH AND PHARYNX IN CASES OF EXTENDED GLOSSECTOMY IN THE COURSE OF A MULTIMODAL TREATMENT OF UICC-STAGE-IV HEAD AND NECK-CANCER

Multimodal approach and improved surgical techniques enable the head a nd neck surgeon to operate even far advanced tumours of the head and n eck under curative intention. Microanastomosed distant flaps and intes tinal grafts expanded the operative spectrum while having the disadvan tages of being time-consuming and in most cases the necessity to call for the specialist (e.g. the abdominal, vascular surgeon). In 6 cases of total glossectomy combined with hemipharyngectomy and hemimandibule ctomy the possibilities of closing large defects by combined regional and pedicled flaps in the head and neck area are shown. In all of our cases surgical therapy had been placed at the end of therapeutic inter ventions in a multimodal treatment protocol. Treatment started with in duction chemotherapy with a regimen including cisplatin, bleomycin and vindesin sulfate and was followed by a subsequent radiotherapy reachi ng a total reference dose of 60 to 70 Gy. After radiotherapy 5 patient s received adjuvant chemotherapy of 1-4 cycles. Despite the aggressive presurgical treatment, the postoperative complications were minor. In a median survival of 37.5 months there were 3 recurrences, 2 patients died of tumour progression. All of our patients benefited from of the ''salvage-operation'' especially with regard to tumour pain. Quality of the patients' life could be improved upon by percutaneous endoscopi c gastrostomy (PEG) and as well good functional and cosmetic results o f the surgical reconstructions. The results justify the discussion abo ut a palliative indication of extended surgical procedures and reconst ructive surgery in far advanced head and neck cancer in the course of a multimodal treatment regimen.