Surgical strategies to secondary head neck reconstruction after previous operations with or without radiotherapy

Abstract

Abstract: PURPOSE : To discuss the surgical strategies to secondary free tissue transfer after previous operations with or without radiotherapy in head and neck reconstruction. METHODS : Between January 2012 and December 2014, secondary head and neck reconstruction was performed in 13 patients who had undergone previous neck dissection (n=12) and radiation therapy (n=11). All secondary defects were reconstructed with free flaps. Clinical data were recorded for each patient. RESULTS : Nine patients had a recurrent carcinoma, two had a secondary primary cancer, one had undergone an operation for scar release and one had an osteoradionecrosis of mandible after radiotherapy for nasopharyngeal carcinoma. All free flaps survived well and the patients healed without major complications. Anterolateral thigh flap (ALT, n=7), anteromedial thigh flap (AMT, n=1), radial forearm free flap (n=1), fibular flap (n=2) and ALT+AMT flaps (n=2) were used for reconstruction. Transverse cervical vessels (TCVs, n=10), vessels of contra-lateral neck (n=2) and superficial temporal vessels (STV, n=1) were chosen as recipient vessels. The mean follow-up time was 11 months. One patient died of distant metastases and 1 died of local recurrence during follow-up. CONCLUSIONS : In patients who had previously undergone neck surgery with or without radiotherapy, the TCVs are reliable and accessible recipient vessels for microsurgical reconstruction in the head and neck region. If the TCVs are unavailable, the STVs and the vessels of contra-lateral neck can serve as an alternative for microvascular anastomosis. Additionally, the internal or external jugular vein should be dissected carefully to avoid vein grafting.

Key words: Head neck, Free flap, Microsurgical reconstruction, Vessel depleted neck, Radiotherapy, Transverse cervical vessel

CLC Number:

XU Zhong-fei, DUAN Wei-yi, BAI Shuang, TIAN Yu, TAN Xue-xin, SUN Chang-fu, LIU Fa-yu, DAI Wei. Surgical strategies to secondary head neck reconstruction after previous operations with or without radiotherapy[J]. China Journal of Oral and Maxillofacial Surgery, 2016, 14(1): 39-43.

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