Staged Head and Neck Reconstruction: Heresy or a Reasoned Approach in a Select Group of Patients?. Issue 3 (September 2022)

• Record Type: Journal Article
• Authors: Urken, Mark. L.; O'Malley, Quinn; Sandler, Mykayla; Xing, Monica H.; Ansari, Edward; Mundi, Neil; Buchbinder, Daniel; Alon, Eran; Okay, Devin
• Is Part Of: Craniomaxillofacial trauma & reconstruction. Volume 15:Issue 3(2022)
• Page Start: 253
• Page End: 263
• Publication Date: 2022-09
• Subjects: microvascular reconstruction -- mandibular reconstruction -- head and neck -- radiation therapy; Face -- Wounds and injuries -- Periodicals; Face -- Surgery -- Periodicals; Maxilla -- Wounds and injuries -- Periodicals; Maxilla -- Surgery -- Periodicals; Face -- Surgery; Face -- Wounds and injuries; Maxilla -- Surgery; Maxilla -- Wounds and injuries; Maxillofacial Injuries -- Periodicals; Craniocerebral Trauma -- Periodicals; Reconstructive Surgical Procedures -- methods -- Periodicals; Fulltext; Internet Resources; Periodicals; Periodicals; 617.522
• DOI: 10.1177/19433875211031361
• Languages: English
• ISSNs: 1943-3875

Abstract

Study Design: case series. Objective: The restoration of defects in a single procedure with microvascular free flap reconstruction has become a mainstay of head and neck surgery. Yet in patients with complex defects and pre-existing comorbid medical conditions, a staged-reconstructive approach can enhance the safety of the procedure and improve the patient's outcome. Methods: We present 3 representative case examples of a larger series of patients who underwent reconstruction of major defects and discuss the usefulness of a staged-reconstructive approach in the management of complex patients. Results: All 3 patients, with an existing composite defect in the setting of prior radiation therapy, underwent successful staged-reconstructive surgery using a variety of free tissue and regional flap transfers. Conclusions: A staged approach facilitates the reconstruction of complex composite defects, increases vessel availability, and mitigates the risk of flap failure. Although this approach commits the patient to multiple procedures and a more prolonged plan of care, it is preferable to 1 operation in specific complex situations with adverse, high-risk clinical features.