%0 Journal Article
%T Reconstructive Surgery for Head and Neck Cancer Patients
%A Matthew M. Hanasono
%J Advances in Medicine
%D 2014
%R 10.1155/2014/795483
%X The field of head and neck surgery has gone through numerous changes in the past two decades. Microvascular free flap reconstructions largely replaced other techniques. More importantly, there has been a paradigm shift toward seeking not only to achieve reliable wound closure to protect vital structures, but also to reestablish normal function and appearance. The present paper will present an algorithmic approach to head and neck reconstruction of various subsites, using an evidence-based approach wherever possible. 1. Introduction The field of head and neck reconstructive surgery is a dynamic one. Advances made in the last decade are mostly secondary to expanded use of microvascular free flaps [1]. Several flaps, including the anterolateral thigh, fibula osteocutaneous, and suprafascial radial forearm fasciocutaneous free flaps, have emerged as workhorse flaps for reconstructing a wide variety of defects. As the anatomy of these flaps has become more familiar, their reliability and versatility have increased. Reliable wound closure without exposure of vital structures is no longer the only priority. Preserving function, including speech and swallowing, and restoring appearance are the goals in every reconstruction. Free flap success rates now routinely exceed 95 percent or better at most centers [1¨C3]. On top of this, minimizing flap donor site morbidity is an important consideration. Because of the high rate of recurrence as well as long-term complications following major head and neck resections and reconstructions, preservation of recipient vessel options and flap donor sites should also be a consideration. In the following paper, an algorithmic approach to mid-facial, mandibular, oral cavity, and pharyngoesophageal reconstruction will be reviewed and expected outcomes discussed. 2. Mid-Facial Reconstruction Management of mid-facial defects is among the most complicated and controversial areas of head and neck oncologic reconstruction. Options include use of prosthetic obturators, pedicled flaps, and free flaps, sometimes combined with grafts or alloplasts [4]. The popularity of pedicled flaps has declined in recent years due to limited reach and volume. Prosthetic obturators remain a good solution for some patients with limited defects. For extensive defects, obturators may be difficult or impossible to retain, particularly in edentulous patients [5]. Furthermore, obturators are inappropriate for defects that involve resection of the skull base, orbital contents, orbital floor, or soft tissues of the face. Finally, some patients may not like the
%U http://www.hindawi.com/journals/amed/2014/795483/