Microvascular free tissue reconstruction following Mohs' micrographic surgery for advanced head and neck skin cancer

Abstract

Seven consecutive patients from 1986 through 1989 for 8 extensive recurrent and/or irradiated skin cancers of the face and scalp are retrospectively evaluated. One patient was treated by conventional surgical margins, and the limitations of this method in sampling margins are compared to the Mohs' micrographic surgery (MMS) used for the other 6 patients. All were treated with free flaps without flap loss or major complications in spite of advanced age. The advantages of an interdisciplinary approach to achieve maximum cure rates, optimal reconstruction, and minimizing anesthesia time are discussed.

Unusual and Giant Tumors of Head and Neck Region

“…7 Whatever modality is used the aim of treatment is complete eradication of the tumor. 10,35 Despite the advances in medical technology, treatment modalities and reconstructive armamentarium overall survival for head and neck cancers has not improved for the past 30 years. 10,35 Despite the advances in medical technology, treatment modalities and reconstructive armamentarium overall survival for head and neck cancers has not improved for the past 30 years.…”

“…Sentinel lymph node identification and aspiration biopsy is the most valuable tool for the detection of cervical lymph node metastasis, but technically demanding and not widely used. 10,14,47,48 If the patient needs surgery after receiving radiotherapy at therapeutic doses, use of local flaps for reconstruction will be impossible due to vascular damage induced by radiation. 37 Crile introduced the concept of radical neck dissection involving the removal of the sternocleidomastoid muscle, spinal accessory nerve and internal jugular vein producing a severe functional and cosmetic deficiency.…”

“…5,6 Thus successful treatment of head and neck tumors is defined by local control. 10 Paralleling the development in flap surgery and introduction of Mohs_ micrographic surgery technique to the armamentarium of cancer surgery, one-stage primary reconstruction has largely replaced the older multistage procedures. 5,7,8 Surgical treatment involves wide excision of tumors but head and neck region involves many complex and vital anatomic structures located closely to each other and all of these anatomic landmarks have an important role in social communication and expression of individual, so wide excision in head and neck region means decreased function, increased disfigurement and decreased quality of life.…”

“…5 Traditionally, local control is achieved by surgical resection and/or radiation therapy. 10,18,19 However there still remain some cases in which staged reconstruction is safer. Thus reconstruction of head and neck region is still a great challenge and if not performed adequately changes of anatomy or functions can have devastating consequences.…”

Double-Opposing Rotation-Advancement Flaps for Closure of Forehead Defects

“…A variety of wellconceived repairs have been described for the scalp but are infrequently applicable outside of the vertex and especially in the forehead. [2][3][4] Among the best designs, the 3-flap and 4-flap techniques of Orticochea figure prominently. [5][6][7] These flaps are unsuitable for forehead repair, however, because both the incision length and closure would cause significant distortion of the brow and hairline.…”