Role of free tissue transfer following extirpation of advanced head and neck tumours

Extirpation of highly invasive and recurrent tumours of the head and neck in order to achieve possible cure and an improved palliation present a major challenge to the reconstructive surgeons. Free tissue transfer following advanced tumour ablation has the advantages of immediate restoration of function and aesthesis in order to improve quality of life in these patients with limited survival periods. This study was conducted at Hospital University Sains Malaysia from 1998 to 2003. Retrospective study. Seventeen patients with head and neck tumours who underwent immediate reconstruction following tumour extirpation during 5yrs were reviewed. The soft tissue defects ranged from 30 cm[2] to 240 cm[2] while the length of the mandibular defects ranged from 3.5 cm to 15 cm. The free tissue transfer used were nine free fibula osteoseptocutaneous flaps, seven free radial forearm flaps and one composite free scapular osteocutaneous flap combined with latissimus dorsi musculocutaneous flap. Our experience concludes that free tissue transfer offers an important option for closure of composite defects following ablative surgery. They provide improved palliation and good quality of life. Hence their challenges in reconstructive surgery and outcomes are discussed

Composite anterior mandibular defect reconstruction

Single technique of tissue transfer alone may not be sufficient to restore a huge composite defect in the anterior mandibular segment. Combination of a second flap of either regional or free flap is often considered complimentary in the reconstruction of a complex wound in this region. We described an innovative way by combining pedicled submental island flap and a double barrel free fibula osteoseptocutaneous flaps to reconstruct soft tissue and mandible of the mental region. This technique can be considered as a valuable adjunct in the reconstructive armamentarium to provide satisfactory contour, colour and texture match without significant donor site morbidity