Secondary Reconstruction for Head and Neck Cancer Patient

Choi, Eun Kyu; Ahn, Hee Chang

Abstract

The purpose of secondary reconstruction for head and neck cancer patient is to manage complications and to improve functional and aesthetic defects following previous surgery. The complications following primary treament of tumor include radionecrosis in bones and soft tissue following radiotherapy, formation of orocutaneous fistula, dehiscence of wounds, secondary infection in wounds, and total or partial necrosis in transferred flaps. Following the resection of tumor some functional deficiencies appear such as dyspnea, swallowing and chewing difficulty due to strictures of reconstructed aerodigestive tract and bulkness of flap. In addition, we performed adjuvant surgery for aesthetic improvement or prosthetic appliance after head and neck reconstruction. We have experienced secondary reconstructions in 29 patients who underwent previous surgical resection for head and neck cancer from June 1988 to March 2000. Ages ranged from 36 to 77 with an average of 58.3. We have performed free flaps in 21 cases, skin grafts in 3 cases, local or regional flaps in 2 cases, and other adjuvant procedure in 4 cases. Secondary reconstructions were successful in all cases. The complicated wounds and fistulae were healed completely, the aerodigastric tract with the stricture was reconstructed with healthy tissue and respiration and swallowing functions were recovered. Aesthetic improvement and prosthetic appliance were also achieved through secondary adjuvant treatment. In conclusion, the successful secondary reconstruction for head and neck cancer needs a careful preoperative planning and therapeutic strategy. We believe that secondary reconstruction for head and neck reconstruction is very important for these cancer patients even though primary resection had been successfully performed for cancer removal, because it can provide better quality of life and sometimes save the patient's life itself.