RESUMO
A total of 137 patients diagnosed with head and neck cancer underwent ablative surgery and primary free flap reconstruction during a period of 9 years, 2001-2009 (men 73.7 %, women 26.3 %). Surgery included a multidisciplinary approach involving plastic, head and neck, and maxillofacial surgeons. Squamous cell carcinoma (SCC) represented the vast majority of the diagnosed tumors (91.2 %); other tumors represented in the study were malignant melanoma, sarcoma, adenocarcinoma and blastoma. The free flaps (n = 143) used for reconstructive surgery included radial forearm flap (n = 128), fibular flap (n = 13) and rectus abdominis muscular flap (n = 2). Twenty patients (15 %) needed reoperation within 48 h due to clinical signs of hematoma (n = 8) and free flap ischemia (n = 12). Furthermore, we report a total of 12 free flap failures, giving an overall free flap success rate of 92 %. Five patients were treated due to infections at donor site (4 %). The overall survival rate (OS) in male patients diagnosed with oral SCC stage II-IV after 2 and 5 years was 82 and 78 %, respectively. Female patients in the same group displayed a 2- and 5-year OS of 78 and 67 %, respectively. Furthermore, analysis of patients treated for recurrence of primary SCC displayed a 2- and 5-year OS of 70 and 55 %, respectively. We conclude that our multidisciplinary approach and treatment algorithm for head and neck cancer including primary free flap reconstruction reconstitutes a safe and reliable tool.
Assuntos
Carcinoma de Células Escamosas/cirurgia , Retalhos de Tecido Biológico , Neoplasias de Cabeça e Pescoço/cirurgia , Microcirurgia/métodos , Procedimentos de Cirurgia Plástica/métodos , Complicações Pós-Operatórias , Adenocarcinoma/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Sobrevivência de Enxerto , Humanos , Masculino , Melanoma/cirurgia , Pessoa de Meia-Idade , Reoperação/estatística & dados numéricos , Estudos Retrospectivos , Sarcoma/cirurgia , Resultado do TratamentoRESUMO
Autologous breast reconstruction with a perforator flap has become increasingly popular. This paper presents the free lumbar artery perforator (LAP) flap as an option for breast reconstruction. Flap harvest is easy, no muscle is sacrificed and donor-site morbidity is minimal. Anastomosis of the sensory nerve to the fourth intercostal nerve is possible. The successful use of a LAP flap for breast reconstruction is illustrated with a case report, and the surgical technique is described. This method may be a good alternative for patients with relative contraindications to breast reconstruction with a DIEP flap.
