Staged Head and Neck Reconstruction: Heresy or a Reasoned Approach in a Select Group of Patients?

IF 0.8 Q4 DENTISTRY, ORAL SURGERY & MEDICINE Craniomaxillofacial Trauma & Reconstruction Pub Date : 2022-09-01 DOI:10.1177/19433875211031361
Mark L Urken, Quinn O'Malley, Mykayla Sandler, Monica H Xing, Edward Ansari, Neil Mundi, Daniel Buchbinder, Eran Alon, Devin Okay
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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.

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分阶段头颈部重建术:对特定患者来说是异端还是合理的方法?
研究设计:病例系列。目的:微血管游离皮瓣单次修复头颈部缺损已成为头颈部外科的主流。然而,对于有复杂缺陷和先前存在的合并症的患者,分阶段重建方法可以提高手术的安全性并改善患者的预后。方法:我们提出了3例具有代表性的病例,这些患者接受了重大缺陷的重建,并讨论了分期重建方法在复杂患者管理中的有效性。结果:所有3例患者均存在先前放射治疗的复合缺损,均通过各种游离组织和区域皮瓣转移成功地进行了分阶段重建手术。结论:分阶段的方法有助于重建复杂的复合缺损,增加血管的可用性,并降低皮瓣失败的风险。虽然这种方法需要患者进行多次手术和更长时间的护理计划,但在具有不良和高风险临床特征的特定复杂情况下,它优于一次手术。
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Craniomaxillofacial Trauma & Reconstruction
Craniomaxillofacial Trauma & Reconstruction DENTISTRY, ORAL SURGERY & MEDICINE-
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