Reconstruction of Defects in the Head and Neck Using Pedicled or Free Flaps: A Review of 112 Cases.
- Author:
Kwang Hyun KIM
1
;
Myung Whun SUNG
;
Hong Ju PARK
;
Chun Dong KIM
;
Chang Ho LEE
;
Dong Young KIM
;
Jin Young KIM
;
Yang Gi MIN
Author Information
1. Department of Otorhinolaryngology-Head and Neck Surgery, College of Medicine, Seoul National University, Seoul, Korea.
- Publication Type:Original Article
- Keywords:
Pectoralis major myocutaneous flap;
Free flap;
Head and neck reconstruction;
Pharyngoesophageal reconstruction
- MeSH:
Drug Therapy;
Free Tissue Flaps*;
Head and Neck Neoplasms;
Head*;
Humans;
Life Support Care;
Medical Records;
Mouth;
Myocutaneous Flap;
Neck*;
Seoul;
Skin
- From:Korean Journal of Otolaryngology - Head and Neck Surgery
1997;40(11):1585-1592
- CountryRepublic of Korea
- Language:Korean
-
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.
