Principles of Head and Neck Reconstruction: An Algorithm to Guide Flap Selection

Harvey Chim; Christopher J Salgado; Rimante Seselgyte; Fu-Chan Wei; Samir Mardini

doi:10.1055/s-0030-1255332

Seminars in Plastic Surgery, Table of Contents

Semin Plast Surg 2010; 24(2): 148-154
DOI: 10.1055/s-0030-1255332

Principles of Head and Neck Reconstruction: An Algorithm to Guide Flap Selection

Harvey Chim¹ , Christopher J. Salgado² , Rimante Seselgyte³ , Fu-Chan Wei⁴ , Samir Mardini³

¹Department of Plastic Surgery, Case Western Reserve University, Cleveland, Ohio
²Department of Plastic Surgery, University of Miami, Miami, Florida
³Division of Plastic Surgery, Mayo Clinic, Rochester, Minnesota
⁴Department of Plastic Surgery, Chang Gung Memorial Hospital, Linkou, Taiwan

Abstract

ABSTRACT

Advances in head and neck reconstruction have resulted in improved outcomes with single-stage repair of defects ranging from intraoral to pharyngoesophageal to skull base defects. Key to success of surgery is choosing an appropriate reconstructive option based on the patient's wishes and fitness for major surgery. Where possible, free tissue transfer provides the best functional and aesthetic outcomes for the vast majority of defects. In this article, we present an algorithm to guide choice of flap selection and review principles of reconstruction and secondary surgery for head and neck defects.

KEYWORDS

Flap selection - free tissue transfer - integrity-function-form - reverse reconstructive ladder

Full Text

References

REFERENCES

1 Emerick K S, Tomycz L, Bradford C R et al.. Primary versus secondary tracheoesophageal puncture in salvage total laryngectomy following chemoradiation. Otolaryngol Head Neck Surg. 2009; 140 386-390
2 Chen H C, Mardini S, Yang C W. Voice reconstruction using the free ileocolon flap versus the pneumatic artificial larynx: a comparison of patients' preference and experience following laryngectomy. J Plast Reconstr Aesthet Surg. 2006; 59 1269-1275
3 Cordeiro P G, Bacilious N, Schantz S, Spiro R. The radial forearm osteocutaneous “sandwich” free flap for reconstruction of the bilateral subtotal maxillectomy defect. Ann Plast Surg. 1998; 40 397-402
4 Biglioli F, Autelitano L. Reconstruction after total parotidectomy using a de-epithelialized free flap. J Craniomaxillofac Surg. 2007; 35 364-368
5 Iida T, Nakagawa M, Asano T, Fukushima C, Tachi K. Free vascularized lateral femoral cutaneous nerve graft with anterolateral thigh flap for reconstruction of facial nerve defects. J Reconstr Microsurg. 2006; 22 343-348
6 Menick F J. Artistry in aesthetic surgery. Aesthetic perception and the subunit principle. Clin Plast Surg. 1987; 14 723-735
7 Burget G C, Menick F J. The subunit principle in nasal reconstruction. Plast Reconstr Surg. 1985; 76 239-247
8 Bridger A G, O'Brien C J, Lee K K. Advanced patient age should not preclude the use of free-flap reconstruction for head and neck cancer. Am J Surg. 1994; 168 425-428
9 Malata C M, Cooter R D, Batchelor A G, Simpson K H, Browning F S, Kay S P. Microvascular free-tissue transfers in elderly patients: the Leeds experience. Plast Reconstr Surg. 1996; 98 1234-1241
10 Chick L R, Walton R L, Reus W, Colen L, Sasmor M. Free flaps in the elderly. Plast Reconstr Surg. 1992; 90 87-94
11 Karanas Y L, Antony A, Rubin G, Chang J. Preoperative CT angiography for free fibula transfer. Microsurgery. 2004; 24 125-127
12 Fukaya E, Saloner D, Leon P, Wintermark M, Grossman R F, Nozaki M. Magnetic resonance angiography to evaluate septocutaneous perforators in free fibula flap transfer. J Plast Reconstr Aesth Surg. 2009; , July 4 (Epub ahead of print)
13 Rozen W M, Ashton M W, Stella D L et al.. Developments in perforator imaging for the anterolateral thigh flap: CT angiography and CT-guided stereotaxy. Microsurgery. 2008; 28 227-232
14 Hidalgo D A. Aesthetic improvements in free-flap mandible reconstruction. Plast Reconstr Surg. 1991; 88 574-585; discussion 586–587
15 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
16 Wookey H. The surgical treatment of carcinoma of the hypopharynx and the oesophagus. Br J Surg. 1948; 35 249-266
17 Edgerton Jr M T. Replacement of lining to oral cavity following surgery. Cancer. 1951; 4 110-119
18 Bakamjian V Y. A two-stage method for pharyngoesophageal reconstruction with a primary pectoral skin flap. Plast Reconstr Surg. 1965; 36 173-184
19 Ariyan S. The pectoralis major myocutaneous flap. A versatile flap for reconstruction in the head and neck. Plast Reconstr Surg. 1979; 63 73-81
20 Theogaraj S D, Merritt W H, Acharya G, Cohen I K. The pectoralis major musculocutaneous island flap in single-stage reconstruction of the pharyngoesophageal region. Plast Reconstr Surg. 1980; 65 267-276
21 Seidenberg B, Rosenak S S, Hurwitt E S, Som M L. Immediate reconstruction of the cervical esophagus by a revascularized isolated jejunal segment. Ann Surg. 1959; 149 162-171
22 Panje W R, Bardach J, Krause C J. Reconstruction of the oral cavity with a free flap. Plast Reconstr Surg. 1976; 58 415-418
23 Harashina T, Fujino T, Aoyagi F. Reconstruction of the oral cavity with a free flap. Plast Reconstr Surg. 1976; 58 412-414
24 Yang G, Chen B, Gao Y et al.. Forearm free skin flap transplantation. Natl Med J China. 1981; 61 139
25 Taylor G I, Townsend P, Corlett R. Superiority of the deep circumflex iliac vessels as the supply for free groin flaps. Plast Reconstr Surg. 1979; 64 595-604
26 Hidalgo D A. Fibula free flap: a new method of mandible reconstruction. Plast Reconstr Surg. 1989; 84 71-79
27 Song Y G, Chen G Z, Song Y L. The free thigh flap: a new free flap concept based on the septocutaneous artery. Br J Plast Surg. 1984; 37 149-159
28 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; discussion 2227–2230
29 Lin Y T, Lin C H, Wei F C. More degrees of freedom by using chimeric concept in the applications of anterolateral thigh flap. J Plast Reconstr Aesthet Surg. 2006; 59 622-627
30 Koshima I, Yamamoto H, Hosoda M, Moriguchi T, Orita Y, Nagayama H. Free combined composite flaps using the lateral circumflex femoral system for repair of massive defects of the head and neck regions: an introduction to the chimeric flap principle. Plast Reconstr Surg. 1993; 92 411-420
31 Koshima I, Hosoda S, Inagawa K, Urushibara K, Moriguchi T. Free combined anterolateral thigh flap and vascularized fibula for wide, through-and-through oromandibular defects. J Reconstr Microsurg. 1998; 14 529-534
32 Chiu E S, Liu P H, Friedlander P L. Supraclavicular artery island flap for head and neck oncologic reconstruction: indications, complications, and outcomes. Plast Reconstr Surg. 2009; 124 115-123
33 Chow T L, Chan T T, Chow T K, Fung S C, Lam S H. Reconstruction with submental flap for aggressive orofacial cancer. Plast Reconstr Surg. 2007; 120 431-436
34 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; discussion 1161–1162
35 Okazaki M, Asato H, Takushima A et al.. Analysis of salvage treatments following the failure of free flap transfer caused by vascular thrombosis in reconstruction for head and neck cancer. Plast Reconstr Surg. 2007; 119 1223-1232
36 Tan N C, Cigna E, Varkey P, Liu Y T. Debulking of free myocutaneous flaps for head and neck reconstruction using an arthroscopic shaver. Int J Oral Maxillofac Surg. 2007; 36 450-452
37 Kim A J, Suh J D, Sercarz J A et al.. Salvage surgery with free flap reconstruction: factors affecting outcome after treatment of recurrent head and neck squamous carcinoma. Laryngoscope. 2007; 117 1019-1023
38 Gleich L L, Ryzenman J, Gluckman J L, Wilson K M, Barrett W L, Redmond K P. Recurrent advanced (T3 or T4) head and neck squamous cell carcinoma: is salvage possible?. Arch Otolaryngol Head Neck Surg. 2004; 130 35-38
39 Miller M J, Schusterman M A, Reece G P, Kroll S S. Use of interposition vein grafts in head and microsurgery. J Reconstr Microsurg. 1994; 10 133-134
40 Yu P. The transverse cervical vessels as recipient vessels for previously treated head and neck cancer patients. Plast Reconstr Surg. 2005; 115 1253-1258
41 Harris J R, Lueg E, Genden E, Urken M L. The thoracoacromial/cephalic vascular system for microvascular anastomoses in the vessel-depleted neck. Arch Otolaryngol Head Neck Surg. 2002; 128 319-323
42 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
43 Caliceti U, Piccin O, Cavicchi O, Contedini F, Cipriani R. Anterolateral thigh free flap for tracheal reconstruction after parastomal recurrence. Head Neck. 2009; 31 1107-1111
44 Mardini S, Wei F C, Salgado C J, Chen H C. Reconstruction of the reconstructive ladder. Plast Reconstr Surg. 2005; 115 2174

Samir MardiniM.D.

Division of Plastic Surgery

Mayo Clinic, Rochester, MN 55905

Email: mardinis@aol.com