head and neck reconstruction surgery
The technique of puncture and valve placement can be employed in the native esophagus or the neoesophagus. (Reprinted from Fisher M, Dorafshar A, Bojovic B, et al. The challenge for reconstruction is not only the aesthetic result, but the functional repair. An osteocutaneous ulnar forearm flap incorporating a portion of ulna bone is possible, but it is not commonly used. 14.5 ) shares similar traits and offers additional benefits over the radial forearm flap (discussed below). In certain cases, craniofacial bone defects can be reconstructed with an alloplastic implant covered by a vascularized soft tissue flap. Although multiple classification systems for midface defects exist, their attempts to define the best free flap choice for reconstruction have not been universally accepted. The goals of midface reconstruction are to preserve projection of the midface and to restore the skeletal buttresses. With the synthesis of microsurgery and craniofacial surgery, surgeons now recognize the importance of reconstructing both soft and hard tissue. Along with treating disorders and cancers of these regions he also does advanced complex reconstructions. In pediatric esophageal replacement, a meta-analysis found that stricture rates were higher in jejunal free flaps compared with colonic and gastric conduits. Examples of such flaps include the radial forearm flap and the ALT flap, which allow for nerve coaptation of the … Alternatively, the anterolateral thigh flap may be used if large amount of skin and soft tissue is required. Vascularized bone is the preferred choice when defects of the midface require free tissue transfer (such as a free fibula flap). Alternatively, a more accurate method of tracing the ulnar artery is completed with a Doppler probe. showed success with arterial-only anastomosis using adjunct leech therapy in two patients. This can be as simple as closing a cut on the head to a major surgery after a car accident. Prior to the adoption of clinical microsurgery, the traditional tongue reconstruction following total or subtotal glossectomy was pectoralis or trapezius pedicled flaps, primarily to achieve wound closure. Distally, the ulnar artery gives off the anterior and posterior ulnar recurrent arteries, followed by the common interosseous artery. Additionally, there is a midline frontoethmoid-vomerine buttress. The vertical buttresses, inferior orbital rim, and alveolar ridge fall within the scope of midface reconstruction. The ulnar forearm flap ( Fig. A total of 533 cases underwent head and neck free flap reconstruction at Peking University School of Stomatology were reviewed for system development. Surgeons at Perlmutter Cancer Center are pioneers in using reconstructive techniques, which are usually performed at the same time as tumor removal. Our consultant plastic surgeons work as part of a multidisciplinary team with the Trust’s ear nose and throat (ENT) department, to provide reconstructive surgery at Charing Cross Hospital following treatment for head and neck cancers.. We have an international reputation and extensive experience in treating skull base cancers and are experts in both soft tissue and bone-based reconstructions. Vanderbilt Head and Neck Surgery fellows become leaders in the field, both in academic and clinical settings. The denervated flap may thin over time, which is why an already minimal volume of soft tissue can thin and may expose underlying hardware. Thus, an understanding of free flaps, their expected appearance on cross-sectional imaging, and their associated complications … Esophageal reconstruction can be accomplished using multiple tissue types as conduits. Osteoradionecrosis and prior chronic infections are not absolute contraindications for using alloplastic material, but the surgeon must be vigilant in ensuring the maximal removal of any infectious burden to the defect. 2018 Dec;34(6):597-604. doi: 10.1055/s-0038-1676076. SURGERY RESULTING FROM CANCER TREATMENT IS KNOWN AS HEAD AND NECK CANCER RECONSTRUCTION. Current recommendations suggest free flap coverage is indicated for forehead defects >50 cm 2 . It is known to be the first part of the face that a stranger sees. The most commonly used replacement organ for the esophagus is the stomach, either completely intact or tabularized, depending on the extent of esophageal excision and gastric involvement. Although the reconstructive ladder is dogmatic to the practice of many plastic surgeons, free tissue transfer has long been established as a form of “jumping” the “steps” of the ladder. Postoperative complications are common, which often leads to prolonged hospital stay. When thin soft tissue is needed with a long pedicle, the ulnar forearm flap is a good choice, with the additional benefit of a favorable donor site and hairless skin. Guided by the critical concepts described above, soft tissue reconstruction should include excess soft tissue with the expectation that volume loss will occur. Understanding the lines of demarcation between facial segments and appreciating the variation in skin thickness throughout the face can aid the surgeon in using skin grafts from areas with similar characteristics to the site being reconstructed. Understanding the Surgery Because the lips, mouth, tongue, throat, and voice box are so vital for normal everyday function and appearance, proper reconstruction is critical. The advantages of the jejunal free flap include its durability, sufficient quantity, and limited effect on physiologic effect of gastrointestinal function. Whether they follow cancer or dental treatments, or as an entirely separate procedure, we have unparalleled experience in a range of minimally invasive reconstructive procedures. Examples of such flaps include the radial forearm flap and the ALT flap, which allow for nerve coaptation of the lingual nerve for sensation and hypoglossal nerve to minimize atrophy and maximize function. Once identified, vessel replantation may require supermicrosurgery. If composite defects accompany tongue resection, the fibula flap and DCIA are ideal sites for obtaining bone, muscle, and skin. The purpose of repairing tongue defects is to reestablish its function to propel a bolus of food toward the pharynx, restore ability to vocalize intelligible speech, prevent aspiration, and optimize aesthetic appearance of the oral cavity and face. Patient-specific needs must be considered in the risk–benefit analysis of selecting a flap, especially in the elderly, with respect to donor site morbidity, those with physical disabilities, and in the actively growing young person. The extent of resection, involvement of esophageal resection, exposure to radiation, prognosis, prior abdominal surgeries, and previously failed voice rehabilitation aid the microsurgeon in selecting optimal patients and optimal approaches to reconstruction. The ulnar nerve is intimately associated with the ulnar artery as it courses over the distal two-thirds of the forearm and is found just ulnar and slightly superficial to the artery. We are proud to offer a comprehensive and multi-disciplinary program in Head & Neck Surgery — Reconstruction Surgery. However, the advantages of the ulnar flap are its similar skin composition of facial components and relative soft tissue paucity that can act as a “double-edged sword,” in scenarios where more soft tissue is necessary. The application of the previously described seven head and neck concepts will dictate which elements must be reconstructed as the best flap choice, since optimal reconstruction is not restricted to one type of flap. Microvascular head and neck reconstruction is a technique for rebuilding the face and neck using blood vessels, bone and tissue, including muscle and skin from other parts of the body. 14.6 ), and forehead defects. Critical Concepts of Craniofacial Microvascular Reconstruction Aesthetic Subunit Appearance . Another 131 cases undergone the same surgery were included for system verification. The maximum skin paddle size measures approximately 15 × 10 cm, similar to the area of the radial forearm skin paddle. 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