Reconstruction of Defects in the Head and Neck Using Pedicled or Free Flaps: A Review of 112 Cases

Kim, Kwang Hyun; Sung, Myung Whun; Park, Hong Ju; Kim, Chun Dong; Lee, Chang Ho; Kim, Dong Young; Kim, Jin Young; Min, Yang Gi

Abstract

BACKGROUND: Despite recent advances in radiation therapy and chemotherapy, surgical procedures remain the primary modality of head and neck cancer therapy. Adequate surgical resection frequently requires the removal of significant amounts of tissue. In addition to the prolongation of life, the restoration of a functional aerodigestive tract is the primary concern of the reconstructive surgeon.
OBJECTIVE
With the above in mind, we have evaluated our experience with head and neck reconstruction using various flaps.
MATERIALS AND METHODS
The medical records of 95 patients who underwent 112 reconstructive surgeries in the head and neck area from 1983 to 1996 in Seoul National University Hospital were reviewed. Results were evaluated with emphasis on the functional aspect and postoperative course.
RESULTS
Successful transfer using PMMC flaps were achieved in 100%, 93% in skin defect and oral/oropharyngeal defect, respectively. In pharyngoesophageal reconstruction, free and visceral flaps had higher success rates and lower complication rates than pectoralis major myocutaneous(PMMC) flaps(75% vs. 64%, 64% vs. 25%). The average completion time to oral intake in pharyngoesophageal reconstruction was within 2 weeks using free and visceral flaps, but within 29 days using PMMC flaps.
CONCLUSIONS
PMMC flap is still a workhorse for head and neck reconstruction. Reconstruction with PMMC flap is adequate for skin, oral or oropharyngeal reconstruction, but inadequate for pharyngoesophageal reconstruction especially for circumferential defect. Those patients reconstructed with visceral flaps were able to tolerate oral feedings sooner and were less likely to have local complications than those with PMMC flaps. Thin myocutaneous flaps such as platysma flap can be used for myomucosal defect of oral cavity as adequately as free flaps.