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November 2007

Update on Major Reconstruction of the Head and Neck

Author Affiliations
 

Author Affiliations: Department of Otolaryngology, Oregon Health and Science University, Portland (Dr Wax); Department of Otolaryngology–Head and Neck Surgery, University of California, Irvine, Orange (Dr Kim); Department of Otolaryngology–Head and Neck Surgery, University of Texas Southwestern Medical Center, Dallas (Dr Ducic); and Department of Otolaryngology and Facial Plastic Surgery, John Peter Smith Hospital Ft Worth, Ft Worth, Texas (Dr Ducic).

Correspondence: Mark K. Wax, MD, FRCSC, Department of Otolaryngology, Oregon Health and Science University, 3181 SW Sam Jackson Park Rd, PV-01, Portland, OR 97239 (waxm@ohsu.edu).

Arch Facial Plast Surg. 2007;9(6):392-399. doi:10.1001/archfaci.9.6.392
Abstract

Reconstruction of soft-tissue defects in the head and neck is best accomplished using similar composite tissue. In the head and neck, this tissue is usually available in the form of adjacent tissue transfer. The local adjacent tissue resembles the resected tissue in color and composition. In some circumstances, the local tissue is not suitable for transfer. This may be due to previous surgery, exposure to radiation, or a defect that is too large for local tissue transfer. In these cases, free tissue transfer may be needed. Free tissue transfer allows for the replacement of similar composite tissue that has not seen previous treatment. The diversity of sites that may be harvested allows a relatively similar tissue match. This article discusses recent advances in the reconstruction of 3 areas that in the past have presented many problems to the reconstructive surgeon. Total nasal and lip reconstruction have been problematic. In heavily pretreated patients, the reconstruction often results in suboptimal outcomes. Large scalp defects in the setting of previous excisions or irradiation are difficult to reconstruct and rehabilitate. In all of these cases, the ability to transfer composite tissue has improved the functional and cosmetic outcomes.

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