Title: The Outcome of Failed Flaps in Reconstruction of Head and Neck Malignancy Resections: what is the Next Reconstruction Option?

Authors: Sunilkumar Mallanaik, Arun Holenarasipur Narasannaiah, Mohan Kakola, Santhoshkumar TB

 DOI:  https://dx.doi.org/10.18535/jmscr/v6i3.86

Abstract

Background: The Free Flaps are the “workhorse” in the Reconstruction of Head and Neck Malignancy Composite Resections. Use of free flaps has less clarified and the failure of free flap remains undermined.

Materials and Methods: This is a retrospective analysis of the cause and outcome of failed free flaps (and pedicled flap transfers performed at tertiary hospital) for head and neck tumours done at a tertiary care center. The consecutive cases of Head Neck Reconstructions done from Dec 2015 to Dec 2016 were taken for the study.

Results: Over the past 1 year (2015-16), there are 33 head and neck reconstructions were performed, 20 by free-tissue transfers and 13 pedicle flaps for head and neck tumours. About 6 flaps failures (18% total plus partial failure rate) were encountered of which four free flap failures and 2 pedicled flap partial failures were noted. Among them one PMMC and one Deltopectoral, were debrided and later Secondary Skin grafting done.

Conclusion: In conclusion, Tissue transfer is more effective in the head and neck region tissue.  Second flap surgery is not much effective in the head and neck region.

Keyword: Free flap surgery, reconstruction, head and neck tumours, pedicle flaps.

References

  1. Hanasono MM, Friel, MT, Klem C et al. Impact of reconstructive microsurgery in patients with advanced oral cavity cancers. Head and Neck 2009;31(10):1289-96.
  2. Hidalgo DA, Disa JJ, Cordeiro PG, Hu QY. A review of 716 consecutive free flaps for oncologic surgical defects: refinement in donor-site selection and technique. Plastic and Reconstructive Surgery 1998;102(3):722–32.
  3. Blackwell KE. Unsurpassed reliability of free flaps for head and neck reconstr-uction. Archives of Otolaryngology Head and Neck Surgery 1999;125 (3):295–99.
  4. Marx RE, Morales MJ. The use of implants in the reconstruction of oral cancer patients. Dent Clin N Am 1998;42:177–202.
  5. Fletcher SG. Speech production following partial glossectomy. J Speech Hear Disord 1988;53:232–8.
  6. Logemann JA. Rehabilitation of the head and neck cancer patient. Semin Oncol 1994;21:359–65.
  7. Sessions RB, Hudkins C. Complications of surgery of the oral cavity. In: Eisele DW, editor. Complications in head and neck surgery. Baltimore: Mosby; 1993.p.218–22.
  8. Lowry JC. Thromboembolic disease and thromboprophylaxis in oral and maxillofacial surgery: experience and practice. Br J Oral Maxillofac Surg 1995;33:101–6.
  9. Franceschi D, Gupta R, Spiro RH, Shah JP. Improved survival in the treatment of squamous carcinoma of the oral tongue. Am J Surg 1993;166:360–5.
  10. Vikram B, Strong EW, Shah JP, Spiro R. Failure at the primary site following multimodality treatment in advanced head and neck cancer. Head Neck Surg 1984;6:720–3.
  11. Vikram B, Strong EW, Shah JP, Spiro R. Failure in the neck following multimod-ality treatment for advanced head and neck cancer. Head Neck Surg 1984;6:724–9

Corresponding Author

Dr Sunilkumar Mallanaik

Senior Resident, Department of Plastic Surgery,

Bangalore Medical College and Research Centre, Bangalore, Karnataka, India

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