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Head and neck reconstructive surgery

Nowadays, microsurgical free flaps are the accepted standard of care for head and neck reconstruction after tumor extirpation. Reconstruction after cancer tries to restore both the appearance and function of the involved body's area such as the face, scalp, ears, nose, mouth, tongue, throat and glands of the face and neck after radiotherapy. After more than 30 years of development, microsurgical free flaps are today considered state of the art in head and neck reconstruction after composite tumor resections. Free flaps provide superior functional and aesthetic restoration with less donor-site morbidity.

This subspecialty includes complex reconstruction of oral and cervical region following cancer resection. Head and neck cancer is closely related to exposure to toxic substances such as alcohol consumption and smoking.

If the tumor is on the skin surface, simple surgical removal and closure will be performed. However, in case the tumor is larger, complex surgical procedures will be required. Surgeons take skin grafts from other parts of the body in order to fill the defect and they reconnect tiny blood vessels for providing adequate circulation thorugh microsurgical techniques.

Another important and relevant feature is the involvement of regional lymphatic nodes that act as a barrier for tumor spread to distant organs and tissues.

Surgery of the head and neck is challenging since these areas are essential for the patient. Issues such as communicating, mastication, swallowing, speech, facial expression and preventing blowout of the great vessels of the head and neck need to be considered during reconstructive procedure as they are vital functions for the patient. Restoring the alimentary tract, face, and neck must be the main goal of plastic surgeons.

Due to the aggressiveness, rapid growth of these tumors and the proximity of important structures, the treatment often requires use of pre-postoperative neo-adjuvant radiotherapy and / or chemotherapy. The adverse effects of these treatments often determine the reconstructive surgery. Well-vascularized microsurgical flaps play an important role in treatment algorihtm of head & neck cancer patient.

• Microsurgical flaps.
• Local and regional skin flaps for facial and neck reconstruction.

The plastic surgeon should be familiar with all aspects of the reconstructive ladder. In the head and neck, however, aside from some small and superficial defects, free tissue transfer should be the first choice for reconstruction of large or composite defects involving bone, soft tissue, and skin. There are several reasons for this.

The treatment of many cancer patients extends beyond a single surgery and is often a lifelong process, with secondary surgery required for rehabilitation and recurrence.