Local and Locoregional Flaps in Head and Neck Defects

Abstract

BACKGROUND: Local and locoregional flaps are very useful in reconstruction of head and neck defects. Each case should be judged on its merits and selection of flap (local or locoregional) should be done by considering various factors. AIM: To study the etiological factors, type, distribution, management of head and neck defects (post traumatic, post malignancy & congenital) by using local and locoregional flaps and the overall cosmetic effect and function of both donor as well as recipient sites. MATERIAL AND METHODS: 40 patients were studied in a multispecialty hospital admitted in the trauma unit or as OPD patients. After stabilization, especially in trauma patients, patients were fully investigated and treatment protocol was made and reconstruction was done as per protocol. RESULTS: In this study, the mean age of patients was 29.8 years. The main cause of head and neck defects was post traumatic (58%) followed by malignancy (23%), infections (10%) and others (9 %). The mean age for post traumatic defects was 26.42 years. In post malignant defects, Basal cell carcinoma was the major cause of defect (50%) followed by oral malignancy (54%). All the patients with oral carcinoma were tobacco chewers and 50 % were alcoholic. Middle third of face (67%) was most common site for defect followed by scalp (14%), upper third (7%) and lower third face (6%). In the middle third of face, nose (38%) was commonest site of defects followed by cheek (34%) and ears (28%). Local flaps were used in 38% of defects as compared to locoregional flaps (62%). Advancement flaps were mainly done for cheek defects (70%). Rotation and transposition flaps were done mainly for scalp defects. Most common locoregional flap done was median forehead flap (27%) followed by deltopectoral flap. CONCLUSION: Local and locoregional flaps are still very useful in reconstruction of head and neck defects. This is in accordance with Gille's rules of reconstruction i.e." like replaces like". Treatment of the head and neck defects should be individualized. Each case should be judged on its merits and selection of flaps (local or locoregional) should be done by considering various factors like type of defect, site of defect, amount of associated injuries, and the condition of adjacent skin.

OTAF Score: A Novel Scoring System for Selection of an Ideal Local and Locoregional Flap for Oncoplastic Head and Neck Reconstruction

“…However, in the present study none of forehead flap was found to reach beyond the midface. Nasolabial flap was reported by Multani et al, [3] as an ideal source for nasal reconstruction and the flap can reconstruct outer or inner lining of nasal defects in consistence with the current study. As regards to the safety to harvest island submental flap, during excision of the submandibular gland it must be performed with attention to the submental vessels on the superior glandular surface otherwise the pedicle could be injured [1].…”

“…Multani et al, reported in their review that nasolabial flaps in nasal reconstruction were the ideal source regarding color, nature and texture match. Furthermore, donor site morbidity is minimal owing to placing its scar along the nasolabial fold [3]. In the present study, also, we reported maximal color, nature and texture match with nasolabial flap in nasal reconstruction when achievable.…”

“…By considering multiple criteria in each flap, the reconstruction of defects could be individualized by judgement of these cases and the more suitable flap for each. The defect management is related to many factors such as defect site, size, patient comorbidity as well as the etiology of the defect weather traumatic or post malignancy which necessitates some specialized management and reconstruction as well [3].…”

“…From the oncological point of view, flap reconstruction of the defects should be compatible with some oncological considerations like cervical lymph node dissection and radiotherapy. Technical, aesthetic and functional factors are also so important in the reconstruction decision [3].…”

“…Also, it has good color match with the face [5]. Paramedian Forehead flap is an axial flap based on supratrochlear artery which is very useful for repair of nasal defects with good functional and cosmetic outcome [3,10]. The nasolabial flap usually used for facial defects especially nasal reconstruction because of its unique colour and texture match to that of the nose [6].…”