Microvascular flaps in head and neck reconstruction

Abstract

Twenty-six patients with head and neck tumors were submitted to 27 microvascular reconstructive procedures. In 15, the mandible was reconstructed using the rib (4), iliac crest (7), and scapula (4). Nine patients underwent craniofacial reconstructions with the latissimus dorsi (5), rectus abdominis (2), greater omentum (2), and scapular (1) flaps. Two patients received a jejunum (1) and a stomach plus greater omentum (1) flaps for pharyngoesophageal reconstruction. Three illustrative cases, one from each group, are presented in detail. Good results were obtained in 22 patients (85%), with both functional and morphological rehabilitation. There were five flap losses (two in the same patient) due to thrombosis of the microvascular anastomoses. There was no operative mortality, and the average operative time was 11 hours. The good results observed in these very advanced cases show that there is a place for these complex procedures in the treatment of selected cases of head and neck tumors.

5th Rib Osteo-pectoralis Major Myocutaneous Flap—Still a Viable Option for Mandibular Defect Reconstruction

“…Use of rib graft has been questioned owing to the problem of high bone resorption rate [14,15]. Bony resorption is not only a problem for the rib graft but also for the free composite flaps, though the problem may be less [16,17]. Earlier studies have shown that when the rib is harvested together with pectoralis major as 5th rib osteo-pectoralis major myocutaneous flap, the problem of rib resorption is minimised [12,19,20].…”

Current advances in reconstruction of the mandible in head and neck cancer surgery

“…Microvascular bone-periosteal grafts have intentionally not been included in this writing because it is the author's opinion that they do not represent a true advance in jaw reconstruction. Although microvascular bone transfers from the radius [ [20]. In addition, many microvascular bone transfers incur longer intensive care time and hospital courses.…”

Colgajos Microvascularizados en Reconstrucción Maxilofacial: Avances de la Microcirugía

“…Con el avance de la tecnología, el mayor número de casos de cáncer y tumores de grandes tamaños y la aparición de tratamientos en base a la quimioterapia e irradiación, se tornó imperiosa la necesidad de contar con colgajos de mayor extensión y pronósticos más predecibles. Así los colgajos libres obtuvieron un lugar relevante en la reconstrucción maxilofacial apoya-dos posteriormente por la microcirugía (Morais-Besteiro et al, 1990;Serra et al, 1991;Hirsch et al, 2008).…”