DOI: http://dx.doi.org/10.18203/2349-2902.isj20185006

Coverage in head and neck malignancies; our institutional experience

Milind A. Mehta, Vikrant Ranjan, Prayas Kumar, Pradnya Sarwade

Abstract


Background: Cancer of the head and neck can have a major impact on patients. It is vitally important that the surgeon appreciate the anatomy of the head and neck, the varieties of tumours and their metastatic patterns of spread, the ablative techniques, the adjunctive treatments, and the potential need for reconstruction. The obvious advantages to immediate reconstruction of a defect after ablation of a tumor have been recognized for more than 3 decades and are still valid today.

Methods: Those patients who required reconstructive management were included in the study. The patients with head and neck malignancy were operated in association with ENT surgeon’s team or Onco-surgery team. Reconstruction of the defect was done by Plastic Surgeons.

Results: In this series various types of reconstructive methods ranging from Split thickness skin graft, full thickness skin graft, fasciocutaneous flaps, fascial flaps, muscle flaps and musculo-cutaneous flaps were used. The defects were primarily sutured in 11% patients. The defects were covered with split thickness skin graft in 6.6% patients. Full thickness skin graft was used in 8.8% patients. Local flaps were used in 6.6% and loco regional flaps were used in 60% for coverage of head and neck defects. Free flaps were used in 6.6% of patients.

Conclusions: The study concluded that for management of such defects local flaps were reliable, quick to execute, and capable of covering large defects. It provides skin of excellent colour and texture, and most of the scars are hidden in natural skin folds.


Keywords


Free flap, Head and neck malignancies, Pectoralis major myocutaneous flap

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References


Gupta PC, Murti PR, Ray CS, Sinha DN. Rising incidence of oral cancer in Ahmedabad city. Indian J Cancer. 2014;51(5):67-72.

Steven A. Goldman. Plastic Surgery in: Mathes SJ, editor. 2nd edition, 111 Carcinoma of the Upper Aerodigestive Tract, volume 5, Elsevier: Saunders; 2006:217-251.

Farewell DG, Futran ND. Flap choice in head and neck reconstruction. Facial Plast Surg Clin N Am. 2003;11:107-19.

González-Ulloa M. Regional aesthetic units of the face. Plast Reconstr Surg. 1987 Mar;79(3):489-90.

Rekha R, Vishnu Vardhan Reddy M, Pardhanandana Reddy P. Epidemiological studies of head and neck cancer in south Indian population. Res Cancer Tumor. 2013;2(2):38-44.

Stenson KM. Epidemiology and risk factors for head and neck cancer up to date. Available at: https://www.uptodate.com/contents/epidemiology-and-risk-factors-for-head-and-neck-cancer. Accessed 10 August 2018.

Vigneswaran N, Williams MD. Epidemiological trends in head and neck cancer and aids in diagnosis. Oral Maxillofac Surg Clin North Am. 2014;26(2):123-41.

Rashid M, Sarwar S, Hameed S, Masood T. Experience with lateral cheek rotation flap for the reconstruction of medial cheek soft tissue defects. J Pak Med Assoc. 2006;56(5):227-30.

Gurunluoglu R, Shafighi M, Gardetto A, Piza-Katzer H. Composite skin grafts for basal cell carcinoma defects of the nose. Aesthetic Plast Surg. 2003;27(4):286-92

Milenovic A, Virag M, Uglesic V, Aljinovic - Ratkovic N. The pectoralis major flap in head and neck reconstruction: first 500 patients. J Cranio-Maxillofacial Surg. 2006;34:340-3.

Mehrof AI, Rosenstock A, Neifeld JP, Merritt WH, Theogaraj SD, Cohen IK. The pectoralis major musculocutaneous flap in head and neck reconstruction - analysis of complications. Am J Surg. 1983;146:478-82.

Withers EH, Franklin JD, Madden JJ, Lynch JB. Pectoralis major musculocutaneous flap: a new flap in head and neck reconstruction. Am J Surg. 1979;138(4):537-43.

Hagerty RF, Smith W. The nasolabial cheek flap. Am J Surg. 1958;24:506.

Boyd CM, Baker SR, Fader DJ, Wang TS, Johnson TM. The forehead flap for nasal reconstruction. Arch Dermatol. 2000;136:1365-70.

Rotunda AM, Bennet RG. The forehead flap for nasal reconstruction: how we do it. Skin Therapy Lett. 2006 Mar;11(2):5-9.

Avinash A, Manik S, Vipul N. Lateral Forehead Flap. A Reliable Flap in Difficult Conditions. Clin Surg. 2017;2:1713.

Bakamjian VY, Long M, Rigg B. Experience with the medially based deltopectoral flap in reconstructive surgery of the head and neck. Br J Plastic Surg. 1971;24:174-83.

Bey E, Hautier A, Pradier JP, Duhamel P. Is the deltopectoral flap born again? Role in head and neck reconstruction. Burns. 2009;35:123-9.

Evans GR, Schusterman MA, Kroll SS, Miller MJ, Reece GP, Robb GL, et al the radial forearm free flap for head and neck reconstruction: a review. Am J Surg. 1994;168(5):446-50.

Smolka K1, Kraehenbuehl M, Eggensperger N, Hallermann W, Thoren H, Iizuka T, et al. Fibula free flap reconstruction of the mandible in cancer patients: Evaluation of a combined surgical and prosthodontic treatment concept. Oral Oncol. 2008;44(6):571-81.

Jones NF, Vögelin E, Markowitz BL, Watson JP. Reconstruction of Composite Through and through mandibular defects with double skin paddle fibular osteocutaneous flap. Plast Reconstr Surg. 2003;112(3):758-65.

Khadakban D, Kudpaje A, Thankappan K, Jayaprasad K, Gorasia T, Vidhyadharan S, et al. Reconstructive Indications of Anterolateral Thigh Free Flaps in Head and Neck Reconstruction. Craniomaxillofac Trauma Reconstr. 2015;9(1):40-5.