The Recurring Defect in Head and Neck Reconstruction

ABSTRACT

Despite the advances in head and neck reconstruction, complications and suboptimal reconstructions continue to exist. Soft tissue contraction, failure of a previous reconstruction, and resection of a recurrent tumor all result in a “recurring” defect. A successful reconstruction in these patients requires a detailed knowledge of the patient's history and the details of the previous reconstructive attempts and discussions with the patient and the patient's family to come to terms with realistic goals. As many of these patients have already received radiation therapy and have also exhausted some of the reconstructive flap options and recipient vessels that could be used, the surgeon is faced with the challenge of selecting the best reconstructive method and the optimal timing of reconstruction in these cases. Simple methods of reconstruction can occasionally suffice in completing the reconstruction; however, if the same indications exist and a free flap was performed in the previous setting, usually another flap of the same quality is required to achieve an optimal result in these cases. Patients' characteristics, methods of reconstruction, optimal timing for reconstruction, flap options, and choice of recipient vessels are discussed.

KEYWORDS

Head and neck reconstruction - complications - recurrent defect - multiple reconstructions - free flap reconstruction

REFERENCES

• 1 Kroll S S, Evans G R, Goldberg D. et al . A comparison of resource costs for head and neck reconstruction with free and pectoralis major flaps.  Plast Reconstr Surg . 1997;  99 1282-1286
• 2 Wei F C, Demirkan F, Chen H C. et al . The outcome of failed free flaps in head and neck and extremity reconstruction: what is next in the reconstructive ladder?.  Plast Reconstr Surg . 2001;  108 1154-1160
• 3 Khouri R K, Cooley B C, Kunselman A R. et al . A prospective study of microvascular free-flap surgery and outcome.  Plast Reconstr Surg . 1998;  102 711-721
• 4 Wei F C, Jain V, Celik N, Chen H C, Chuang D C, Lin C H. Have we found an ideal soft-tissue flap?.  <~>An experience with 672 anterolateral thigh flaps. Plast Reconstr Surg . 2002;  109 2219-2226
• 5 Weinzweig N, Gonzalez M. Free tissue failure is not an all-or-none phenomenon.  Plast Reconstr Surg . 1995;  96 648-660
• 6 Wei F C, Demirkan F, Chen H C, Chen I H, Liao C T, Hau S P. Management of secondary soft-tissue deficits following microsurgical head and neck reconstruction by means of another free flap.  Plast Reconstr Surg . 1999;  103 1158-1166
• 7 Miller M J, Schusterman M A. Secondary deformities following mandibular reconstruction.  Clin Plast Surg . 1997;  24 551-563
• 8 Glicksman A, Ferder M, Casale P, Posner J, Kim R, Strauch B. 1457 years of microsurgical experience.  Plast Reconstr Surg . 1997;  100 355-363
• 9 Finical S J, Doubek W G, Yugueros P, Johnson C H. The fate of free flaps used to reconstruct defects in recurrent head and neck cancers.  Plast Reconstr Surg . 2001;  107 1363-1366
• 10 Miller M J, Schusterman M A, Reece G P, Kroll S S. Interposition vein grafting in head and neck reconstructive microsurgery.  J Reconstr Microsurg . 1993;  9 245-251
• 11 Khoo C T, Bailey B N. The behaviour of free muscle and musculocutaneous flaps after early loss of axial blood supply.  Br J Plast Surg . 1982;  35 43-46
• 12 Furukawa H, Yamamoto Y, Sasaki S. et al . Second free jejunal transfer in complicated pharyngoesophageal reconstructions.  J Reconstr Microsurg . 2003;  19 93-98
• 13 Nakayama B, Kamei Y, Toriyama K, Hyodo I, Hasegawa Y, Torii S. Usefulness of a first transferred free flap vascular pedicle for secondary microvascular reconstruction in the head and neck.  Plast Reconstr Surg . 2002;  109 1246-1253
• 14 McKee N H, Clarke H M, Manktelow R T. Survival following vascular compromise in an island skin flap.  Plast Reconstr Surg . 1981;  67 200-204
• 15 Salgado C J, Smith A, Kim S. et al . Effects of late loss of arterial inflow on free flap survival.  J Reconstr Microsurg . 2002;  18 579-584
• 16 Horng S Y, Chen M T. Reversed cephalic vein: a lifeboat in head and neck free-flap reconstruction.  Plast Reconstr Surg . 1993;  92 752-753