Free Abdominal Tissue Transfer and Utilization of the Umbilical Stalk for “Tubular” Reconstruction in Ear, Nose, and Throat Defects

Large head and neck burns and cancer-related defects pose many challenges to the reconstructive surgeon with the ultimate goals being aesthetic, as well as functional restoration, or as the renowned Italian plastic surgeon Gaspare Tagliacozzi espoused to “restore, rebuild, and make whole those parts which nature hath given but which fortune has taken away.” The face, in particular, has inherent structures that are vital to interpersonal relationships, as well as everyday function. Large head and neck burns or cancer defects may require a tracheostomy and stoma creation or reconstruction of the external auditory meatus both posing a significant reconstructive challenge.

Reconstructive options in these large head and neck cases can be limited with the inability to utilize skin grafts, local tissue expansion, or potentially locoregional flaps due to the amount of surrounding scarring, lack of soft tissue, and amount of tissue bulk needed for reconstruction. Therefore, free flap coverage is often needed. Many types of free flaps can be utilized for head and neck reconstruction including the radial forearm or anterolateral thigh (ALT) flap due to their thin and versatile nature; however, abdominal-based free flaps can be uniquely designed to fit the reconstructive purpose of not only wound coverage but also the ability to recreate a vascularized tubed structure. Whether designed as a deep inferior epigastric perforator (DIEP) flap or a free transverse rectus abdominis myocutaneous (TRAM) flap, the abdominal-based free flap is versatile and provides a readily available umbilical opening that functions as a thin, vascularized umbilical stalk that can be utilized for reconstruction of a tubular structure such as the external auditory meatus, nasal passageway, or neck tracheostomy/stoma site. We present four cases in which an abdominal free flap was used to reconstruct large burn and cancer resection defects while providing a channel for tubular reconstruction.

Publication History

Received: 28 May 2020

Accepted: 26 July 2020

Article published online:
06 September 2020

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