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General Principles of Surgical Reconstruction in Head and Neck Cancers

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Resection and Reconstruction of Head & Neck Cancers

Part of the book series: Head and Neck Cancer Clinics ((HNCC))

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Abstract

Head and neck reconstruction is the challenge to surgeon, due to the complicated functional anatomy of the head and neck, and cosmetic concern. Till the 1960s, local or regional flap was used for replacement of head and neck soft tissue. Transbuccal flap, tongue flap, and nasolabial flap were chosen for small tissue defect, whereas forehead flap, temporal flap, and deltopectoral flap were chosen for larger ones. These flaps were selected based on proximity rather than on pattern or blood supply, which caused wound unhealing and higher complication rate. Regional pedicle myocutaneous flaps were introduced in the 1970s. In 1983, Souter reported a case of using free radial forearm flap for oral reconstruction. This provides compound reconstruction with multiple types of tissue including the skin, mucosa, muscle, and bone. In these two decades, the free flap and, more recently, the perforator flap have become gold standard for not only reconstructing the defects but also offering the functional restoration and superior aesthetic result.

In the light of microvascular free tissue transfer, the external carotid branches are commonly used. The facial vein has good caliber and is useful as a recipient for a free tissue transfer. Under the circumstance of neck dissection, the alternatives could be of the recipient vein, such as the internal jugular vein, external jugular vein, and transverse cervical vein. Details for each reconstruction area are listed as below. The protocol of flap surveillance should be inspecting the flap every hour, and any vascular compromise or indication for re-exploration can be noted easily.

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Author information

Authors and Affiliations

  1. Collage of Medicine, School of Medicine, China Medical University, Taichung, Taiwan

    Chang-Cheng Chang

  2. Division of Plastic and Reconstructive Surgery, China Medical University, Taichung, Taiwan

    Chang-Cheng Chang

  3. Division of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Chia Yi, Taiwan

    Yu-Tsung Chen & Jen-Hsiang Shen

  4. Department of Dermatology, Shuang Ho Hospital, Taipei Medical University, Taipei, Taiwan

    Yu-Tsung Chen

  5. Department of Ophthalmology, Chang Gung Memorial Hospital, Linkou, Taiwan

    Jen-Hsiang Shen

Authors
  1. Chang-Cheng Chang
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  2. Yu-Tsung Chen
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  3. Jen-Hsiang Shen
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Editor information

Editors and Affiliations

  1. Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Taoyuan, Taiwan

    Ming-Huei Cheng

  2. Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Taoyuan, Taiwan

    Kai-Ping Chang

  3. Department of Otolaryngology – Head & Neck Surgery, Chang Gung University College of Medicine, Chang Gung Memorial Hospital, Taoyuan, Taiwan

    Huang-Kai Kao

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Chang, CC., Chen, YT., Shen, JH. (2019). General Principles of Surgical Reconstruction in Head and Neck Cancers. In: Cheng, MH., Chang, KP., Kao, HK. (eds) Resection and Reconstruction of Head & Neck Cancers. Head and Neck Cancer Clinics. Springer, Singapore. https://doi.org/10.1007/978-981-13-2444-4_3

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  • DOI: https://doi.org/10.1007/978-981-13-2444-4_3

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  • Publisher Name: Springer, Singapore

  • Print ISBN: 978-981-13-2443-7

  • Online ISBN: 978-981-13-2444-4

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