Mark L Urken, Quinn O'Malley, Mykayla Sandler, Monica H Xing, Edward Ansari, Neil Mundi, Daniel Buchbinder, Eran Alon, Devin Okay
{"title":"Staged Head and Neck Reconstruction: Heresy or a Reasoned Approach in a Select Group of Patients?","authors":"Mark L Urken, Quinn O'Malley, Mykayla Sandler, Monica H Xing, Edward Ansari, Neil Mundi, Daniel Buchbinder, Eran Alon, Devin Okay","doi":"10.1177/19433875211031361","DOIUrl":null,"url":null,"abstract":"<p><strong>Study design: </strong>case series.</p><p><strong>Objective: </strong>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.</p><p><strong>Methods: </strong>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.</p><p><strong>Results: </strong>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.</p><p><strong>Conclusions: </strong>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.</p>","PeriodicalId":46447,"journal":{"name":"Craniomaxillofacial Trauma & Reconstruction","volume":"15 3","pages":"253-263"},"PeriodicalIF":0.8000,"publicationDate":"2022-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/19433875211031361","citationCount":"1","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Craniomaxillofacial Trauma & Reconstruction","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.1177/19433875211031361","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q4","JCRName":"DENTISTRY, ORAL SURGERY & MEDICINE","Score":null,"Total":0}
引用次数: 1
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.