Retrospective study on the effectiveness and indications of different types of flaps used for reconstruction of head and neck

Defects following head and neck surgery can be closed by direct closure when the defect is small, and where local conditions dictate that there is enough lax tissue. Flowever, for larger defects or in situations when direct suture is not applicable, surgical defects may be filled by free grafts, local flaps, pedicled flaps which may be either axial or musculocutaneous, or by using free tissue transfer. This study was conducted in attempt to clarify the success rate of different types of flaps in common use for head and neck reconstruction, the effectiveness of different flaps in terms of functional and esthetic results and which flap is the best for certain defects in head and neck region. In this retrospective study, among the patients with head and neck cancer treated in The Department of Otorhinolaryngology, Head and Neck Surgery, Hiroshima University, in the period from Jan.2004 to Dec.2009, patients whom post ablative defects needed to be reconstructed by flaps were only included. Patients whom defects were repaired either without flaps or by other means of reconstruction [e.g. gastric pull up] were excluded. The flaps among this study were compaired in terms of flap survival and functional outcomes [speech intelligibility, early starting of oral intake and cosmetic appearance]. This study was conducted upon 38 patients, they were 9 [23.68%] females and 29 [76.31%] males with a mean of age of 61 years [range 36- 84 years]. According to the site of the defect needed to be reconstructed after ablation of the primary lesion, patients were divided into three groups: 1-Patients with defects in the oral cavity and oropharynx which resulted from resection of malignant tumors involving or extending into oral cavity and oropharynx [26 patients] [Gl]. 2-Patients with defects in the hypopharynx which resulted from resection of cancer involving the hypopharynx [8 patients] [G2]. 3- Patients with post maxillectomy defects following resection of sinonasal cancer [4 patients] [G3]. In this study all defects resulted from resection of primary lesions were reconstructed immediately after ablation. As regarding patients with oral and oropharyngeal defects [n-26], the most common flap that was used in reconstruction was the pectoralis major myocutaneous flap [PMMF], that was used in ten patients followed by the radial forearm fasciocutaneous free flap that was used in seven patients, transverse rectus abdominas myocuianeous [TRAM] flap that was used in four patients, the fibula osseocutaneous free flap that was used in three patients and lastly the scapula free flap which was used in two patients. For hypopharyngeal defects [n=8], reconstruction was done in all patients with the free jejunal flap except in a single patient that was performed with the pectoralis major myocutaneous flap. In patients with craniosinonasal defects [n4], the TRAM flap was used in four patients to seal the oro-riasal communication and-the fascia lata for reconstruction of the anterior skull base defects. Overall evaluation of different types of flaps for reconstruction of head and neck defects revealed that radial forearm free flap and PMMF is the best two choices in terms of flap survival and functional outcome for reconstruction of oral cavity defects, free jejunal flap gave fair results for reconstruction of the hypopharynx and finally the TRAM flap isn't the best choice for reconstruction of the maxillary defects. Radial forearm free flap and pectoralis major myocutaneous flap [PMMF] are the best choice for reconstruction of oral cavity defects

Surgical treatment of Cranio-facial Neurofibromatosis

Craniofacial neurofibromatosis may cause severe soft tissue deformity together with pulsating exophthalmos. The orbital cavity is often enlarged, and the greater wing of the sphenoid bone is usually absent, the eye is proptotic and blind. In these situations, enucleation of the blind eye with soft tissue excision and orbital reconstruction, followed by replacement with a suitable prosthesis, are recommended. Eight patients with localized craniofacial neurofibromatosis were treated surgically, the results were satisfactory only in two patients, acceptable in four and unsatisfactory in two. This reflects the difficulty in treating the lesion and the need for multiple operative sessions