Developments in reconstructive plastic surgery, owing chiefly to progress in microsurgical techniques, have given new impetus to head and neck excision, permitting more radical cancer treatment, improvement in patients quality of life, with satisfactory cosmetic and functional results, and a drastic reduction in serious postoperative complications. Choice of reconstructive technique must ensure that treatment is radical but at the same time guarantees safety and reliability. Our case study, running from 1992 to 1998, includes 137 patients with oral cancer and/or carcinoma of the oropharynx, stages III and IV, according to UICC (Unio Internationalis Contra Cancrum) criteria. All were submitted for simultaneous surgical resection and reconstruction. The flaps used for reconstruction were: myocutaneous pectoralis major flap, a pedicle flap of temporal muscle and a radial (fasciocutaneous or osteofasciocutaneous) free flap, with a pedicle flap/free flap ratio of approximately 2:1. In addition, 104 monolateral and 28 bilateral laterocervical dissection were performed. Preference for a pectoralis major myocutaneous flap was dictated by: rapid, safe dissection; reliable vascularization; abundantly available tissue both to protect the vascular-nervous axis of the neck and to reconstruct the oral and oropharygeal defect; modest consequences in the donor region, particularly in men. The decision to use fasciocutaneous or osteofasciocutaneous radial flap, rather than another microsurgical option, was based on the following features dissection and flap raising procedures can be conducted simultaneously; it is a long, constant vascular pedicle; it is slender and pliable and can be easily adapted to reconstruction of the structures involved (tongue, soft palate, oral pelvis, etc.); where necessary, a bone graft can be raised, particularly indicated in reconstructions of the ascending and horizontal sections of the mandible; this flap permits sensory reinnervation, promoting improvement of the oral stage of deglutition. Where microsurgical is adopted, far less time is required for recovery of the aforementioned functions and a return to normal social and professional life. Analysis of results and complications, in relation to the surgical protocols employed, prompts the authors to extend indications for use of microsurgical flaps, bearing in mind the superior functional (deglutition, phonation) and cosmetic results achieved.
|Translated title of the contribution||Reconstruction with microsurgical and myocutaneous flaps after surgical resection of the oral and oropharyngeal region: Case study from 1992 to 1998|
|Number of pages||8|
|Journal||Rivista Italiana di Chirurgia Plastica|
|Publication status||Published - 1999|
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