Mark L Urken1,2, Quinn O'Malley1, Mykayla Sandler1, Monica H Xing1, Edward Ansari2, Neil Mundi2, Daniel Buchbinder2, Eran Alon3, Devin Okay2. 1. THANC (Thyroid, Head and Neck Cancer) Foundation, New York, NY, USA. 2. Department of Otolaryngology-Head and Neck Surgery, Icahn School of Medicine at Mount Sinai Hospital, Mount Sinai Beth Israel, New York, NY, USA. 3. Department of Otolaryngology Head and Neck Surgery, The Chaim Sheba Medical Center, Tel-Hashomer, Israel.
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.
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.
Authors: M J Benatar; O Dassonville; E Chamorey; G Poissonnet; M Ettaiche; C S Pierre; K Benezery; R Hechema; F Demard; J Santini; A Bozec Journal: J Plast Reconstr Aesthet Surg Date: 2013-01-23 Impact factor: 2.740
Authors: B P Bengtson; M A Schusterman; B J Baldwin; M J Miller; G P Reece; S S Kroll; G L Robb; H Goepfert Journal: Am J Surg Date: 1993-10 Impact factor: 2.565