Head and neck reconstruction: a review of 117 cases

The reconstruction of defects of the head and neck, no matter the cause, be gins with a careful assessment of the patient and the defect. Ideally, it e nds with the successful execution of the reconstructive procedure that opti mally restores Form and function with minimal morbidity. There are several treatment possibilities that differ in their indications, technical difficu lty, safety, and incidence of complications. This is a review over a period of 13 years of 117 cases of head and neck reconstruction performed by the author. Sixty-eight patients were treated with five different musculocutane ous pedicled flaps, mainly during the first half of the 13-year period. Tho se based on the pectoral major and latissimus dorsi were the most frequentl y utilized, mainly in pharyngolaryngeal reconstructions and sometimes as os teomyocutaneous flaps for oromandibular defects. Forty-nine patients had mi crovascular reconstructive procedures with 12 different types of free flaps . The Latissimus dorsi flap was used for reconstruction of the scalp and af ter excision of intracranial lesions, whereas the serratus anterior or rect us abdominis free flaps were utilized for reconstruction of complex defects of the middle-third of the face. The radial forearm flap and the free jeju num have become the choice for intraoral and pharyngoesophageal reconstruct ion, respectively. Good results were obtained in both functional and social rehabilitation of the patients. There were three flap losses due to thromb osis of the microvascular anastomosis. There was no surgical mortality. The indications for each pedicled and free flap are discussed.