Do multiple consecutive head and neck reconstructions improve the patients functional outcome?

Background: The purpose of this study was to determined the functional outcome of surgically treated head and neck cancer patients who required more than "standard" microsurgical reconstruction.

Methods: Data concerning all patients with head and neck cancers, who underwent free-tissue transfers in our institution between January 1, 1994 and August 31, 1999 were reviewed. The cases of tumor recurrences and those with micro-surgical complications were excluded. Among 68 primary microsurgical reconstructions, we identified five cases where limitations in speech and/or swallowing required additional flap procedures. An objective assessment of speech and swallowing could be performed in four patients.

Results: In these five patients up to three consecutive additional procedured including three free-tissue transfers in one case, had to be performed mainly because of secondary contraction of the surrounding irradiated tissue. A total of 13 pedicled and free flaps were transferred to the head and neck. Three patients underwent two consecutive free tissue transfers. The additional reconstructions were requested to improved tongue mobility in three patients and to enlarge the upper digestive tract in two patients. The mean follow-up was 23 months (range : 9-53 months). Functional evaluation was rated average in three patients and poor in one patient. One patient died before functional evaluation could be performed because of disease. The four patients judged the final cosmetic result as satisfactory.

Conclusion: We report five cases of head and neck microsurgical reconstructions where additional flap procedures were requested because of inadequately restored speech or nutrition capabilities. We show that, maybe because of extensive fibrosis, only limited improvement in the functional outcome can be expected despite the use of even sophisticated microsurgical reconstructions. This paper supports the idea that every effort should be put in the initial reconstruction, as further procedures are of poor functional prognosis.