Secondary Free-Tissue Reconstruction for Metachronous Tumors of the Head and Neck: Techniques, Results, and Outcomes

Abstract

Malignancies of the head and neck are not uncommon in the Far East due to the habit of betel-nut chewing. The development of a second primary neoplasm is a constant fear for those who have had successful treatment of a primary cancer. A total of 82 patients, treated with microvascular reconstruction after surgical resection of head and neck cancer, were studied retrospectively. Twenty-one patients who had repeated reconstructive microsurgery for a second primary head and neck malignancy were enrolled as the study group. Sixty-one patients treated for the first-diagnosed malignancy were considered as the control group. There were no statistical differences between the two groups, either in terms of operation time, hospital stay, successful rate, or complication rate. The results show that, if required, one should not hesitate to repeat the free-tissue transfer after ablating a second primary neoplasm.

Second free tissue transfers in head and neck reconstruction

“…The general trend in the literature is that patients who undergo a second flap have the same or more complications than patients who undergo primary reconstruction do. 4 Donor sites for the second flaps were selected based on the need for composite tissue, the size of the anatomic defect, and the patient's comorbidities. The distribution of flaps from the first and second reconstructions illustrates that a wide variety of donor sites are used for all reconstructions, with use of the contralateral donor site being quite common.…”

“…The use of multiple sequential free flaps has been described in the literature in a few retrospective reviews that consist of fewer than 40 patients. [3][4][5][6][7][8][9] The ability to transfer tissue in the setting of a previous free flap presents many technical problems. Suitable vessels may be difficult to find.…”

“…The fact that they required a free tissue transfer for their first resection almost always means that they will need a second free tissue transfer because of a lack of suitable local tissues. The use of multiple sequential free flaps has been described in the literature in a few retrospective reviews that consist of fewer than 40 patients 3–9 . The ability to transfer tissue in the setting of a previous free flap presents many technical problems.…”

Technical Considerations in Patients Requiring a Second Microvascular Free Flap in the Head and Neck

“…This study supports prior data suggesting that multiple microsurgical reconstructions are safe and effective. [1][2][3][4] The unique aspect of this report compared with its predecessors is the prospective data collection and focus on intraoperative variables. These are logged on a case-by-case basis.…”

Free Flap Outcomes of Microvascular Reconstruction after Repeated Segmental Mandibulectomy in Head and Neck Cancer Patients

“…With advances in operative techniques and perioperative care, the results of tumor ablation followed by immediate free tissue transfer for head and neck cancers have greatly improved. Nonetheless, the 5-year cumulative rate of recurrence or a second primary malignancy remains as high as 5% to 30% even after curative resection in patients with head and neck cancer 1–4 . For selected candidates, repeat resection is the first treatment of choice, and it provides acceptable safety and comparable long-term survival rates with primary resection.…”