Future Directions

The development of free flap reconstruction for the head and neck began with skepticism regarding the safety and reproducibility of transferring tissue to the head and neck. We are now in a second phase in which questions regarding the true value of these techniques in changing the quality of a patient's life are being raised.5 The future success of free flaps seems secure as we gain greater understanding of the pathophysiology of small vessel thrombosis, improvements in instrumentation, and utilization of flaps with longer vascular pedicles. We must continue to ensure that the high level of flap success continues as the techniques become more popular and widely disseminated. Increasingly, otolaryngologists are being exposed to microvascular techniques at both the residency and fellowship levels. One study identified 27 fellowships per year offering some microvascular training within the field of otolaryn-gology-head and neck surgery.47 Close cooperation between head and neck cancer surgeons, microvascular head and neck surgeons, and plastic and reconstructive surgeons is imperative as we move into the second era of free flap evolution. Future studies in this field need to consider cosmetic, functional, and quality-of-life outcomes as more meaningful interpretations of free flap reconstruction, rather than flap survival alone.47 There are relatively few objective reports in this area, especially in head- and neck-specific quality-of-life measures for free flap reconstruction. As we become more capable of extirpating larger tumor volumes and more sophisticated in our reconstructive techniques, we must not lose sight of the impact of these procedures on the lives of our patients.

Song and Myers—CHAPTER 14

1. Shestak KC, Myers EN, Ramasastry SS, et al. Vascularized 4. free-tissue transfer in head and neck surgery. Am J Otolaryngol 1993;14:148-154 5.

2. Jones NF, Johnson JT, Shestak KC, et al. Microsurgical reconstruction of the head and neck: interdisciplinary collaboration between head and neck surgeons and plastic surgeons in 305 6. cases. Ann Plast Surg 1996;36:37-43

3. Schusterman MA, Horndeski G. Analysis of the morbidity associated with immediate microvascular reconstruction in 7.

head and neck cancer patients. Head Neck 1991;13: 51-55

Qattan MM, Boyd BJ. Complications in head and neck microsurgery. Microsurgery 1993;14:187-195 Urken ML, Weinberg H, Buchbinder D, et al. Microvascular free flaps in head and neck reconstruction. Arch (Otolaryngol Head Neck Surg 1994;120:633-640

Truelson JM, Leach JL, Close LG. Reliability of microvascular free flaps in head and neck reconstruction. Otolaryngol Head Neck 1994;111:557-559

McCulloch TM, Jensen NF, Girod DA, et al. Risk factors for pulmonary complications in the postoperative head and neck surgery patient. Head Neck 1997;19:372-377

8. Brown MT, Cheney ML, Gliklich RL, et al. Assessment of functional morbidity in the radial forearm free flap donor site. Arch Otolaryngol Head Neck Surg 1996;122:991-994

9. Mahoney J. Complications of free flap donor sites. Microsurgery 1995;16:437-444

10. Haughey BH, Frederickson JM. The latissimus dorsi donor site. Arch Otolaryngol Head Neck Surg 1991;117:1129-1134

11. Swanson E, Boyd JB, Manktelow RT. The radial forearm flap: reconstructive applications and donor-site defects in 35 consecutive patients. Plast Reconstr Surg 1990;85:258-266

12. Schusterman MA, Miller MJ, Reece GP, et al. A single center's experience with 308 free flaps for repair of head and neck cancer defects. Plast Reconstr Surg 1994;93:472-478

13. Clayman GL, DeMonte F, Jaffe DM, et al. Outcome and complications of extended cranial-base resection requiring microvascular free-tissue transfer. Arch Otolaryngol Head Neck Surg 1995;121:1253-1257

14. Shestak KC, Jones NF, Wu W, et al. Effect of advanced age and medical disease on the outcome of microvascular reconstruction for head and neck defects. Head Neck 1992;14:14-18

15. Shaari CM, Buchbinder D, Costantino PD, et al. Complications of microvascular head and neck surgery in the elderly. Arch Otolaryngol Head Neck Surg 1998;124:407-411

16. Bridger AG, O'Brien CJ, Lee KK. Advanced patient age should not preclude the use of free-flap reconstruction for head and neck cancer. Am J Surg 1994;168:425-428

17. Peters GE, Grotting JC. Free-flap reconstruction of large head and neck defects in the elderly. Microsurgery 1989;10:325-328

18. Malata CM, Cooter RD, Batchelor AGG, et al. Microvascular free-tissue transfer in elderly patients: the Leeds experience. Plast Reconstr Surg 1996;98:1234-1241

19. Brown MR, McCulloch TM, Funk GF, et al. Resource utilization and patient morbidity in head and neck reconstruction. Laryngoscope 1997;107:1028-1031

20. Kroll SS, Evans GR, Goldberg D. A comparison of resource costs for head and neck reconstruction with free and pectoralis major flaps. Plast Reconstr Surg 1997;99:1282-1286

21. Kroll SS, Reece GP, Miller MJ, et al. Comparison of the rectus abdominis free flap with the pectoralis major myocuta-neous flap for reconstructions in the head and neck. Am J Surg 1992;164:615-618

22. Righi PD, Weisberger EC, Slakes SR, et al. The pectoralis major myofascial flap: clinical applications in head and neck reconstruction. Am J Otolaryngol 1998;19:96-101

23. Keidan RD, Kusiak JF. Complications following reconstruction with the pectoralis major myocutaneous flap: the effect of prior radiation therapy. Laryngoscope 1992;102:521-524

24. Shah JP, Haribhakti V, Loree TR, et al. Complications of the pectoralis myocutaneous flap in head and neck reconstruction. Am J Surg 1990;160:352-355

25. Fabian RL. Pectoralis major myocutaneous flap reconstruction of the laryngopharynx and cervical esophagus. Laryngoscope 1988;98:1227-1231

26. Zbar RI, Funk GF, McCulloch TM, et al. Pectoralis major myocutaneous flap: a valuable tool in contemporary head and neck reconstruction. Head Neck 1997;19:412-418

27. Ord RA. The pectoralis major myocutaneous flap in oral and maxillofacial reconstruction: a retrospective analysis of 50 cases. J OralMaxillofac Surg 1996;54:1292-1295

28. Shaha A. A long term follow-up of pectoralis osteomyocutaneous flaps. J Surg Oncol 1992:49:49-51

29. Rassekh CH. Free flap options for common head and neck defects. Facial Plast Surg 1996:12:97-100

30. Jones TR, Jones NF. Advances in reconstruction of the upper aerodigestive tract and cranial base with free tissue transfer. Clin Plast Surg 1992;19:819-831

31. McConnel FMS, Pauloski BR, Logemann JA, et al. Functional results of primary closure vs flaps in oropharyngeal reconstruction. Arch Otolaryngol Head Neck Surg 1998;124:625-630

32. Martin PJ, O'Leary MJ, Hayden RE. Free tissue transfer in oromandibular reconstruction: necessity or extravagance? Otolaryngol Clin North Am 1994;27:1141-1150

33. Wells MD, Edwards AL, Luce EA. Intraoral reconstructive techniques. Clin Plast Surg 1995;22:91-108

34. Thomson JG, Restifo RJ. Microsurgery for cranial base tumors. Clin Plast Surg 1995;22:563-572

35. Schramm V, Myers E, Maroon J. Anterior skull base surgery for benign and malignant disease. Laryngoscope 1979;89: 1077-1091

36. Spirelli HM, Irizarry D, McCarthy JG. An analysis of extradural dead space after fronto-orbital surgery. Plast Reconstr Surg 1994;93:1372-1377

37. McGuirt WF, Davis SP. Demographic portrayal and outcome analysis of head and neck cancer surgery in the elderly. Arch Otolaryngol Head Neck Surg 1995;121:150-154

38. Fried MP. The effects of radiation therapy in microvascular anastomosis. Laryngoscope 1985;37(suppl):1-33

39. Cunningham BL, Shons AR. Free tissue transfer in rats using an irradiated recipient site. Br J Plast Surg 1979;32:137-140

40. DeWilde RL, Donders G. Scanning electron micrographic study of microvascular anastomoses on irradiated vessels: long-term effects of radiation. Microsurgery 1986;7:156-157

41. Kiener JL, Hoffman WY, Mathes SJ. Influence of prior radiotherapy on microvascular reconstruction in the head and neck region. Am J Surg 1991;162:404-407

42. Bengtson BP, Schusterman MA, Baldwin BJ, et al. Influence of prior radiotherapy on the development of postoperative complications and success of free tissue transfer in head and neck cancer reconstruction. Am J Surg 1993;166:326-330

43. Keidan RD, Kusiak JF. Complications following reconstruction with the pectoralis myocutaneous flap: the effect of prior radiation therapy. Laryngoscope 1992;102:521-524

44. Kim KA, Chandrasekhar BS. Cephalic vein in salvage micro-surgical reconstruction in the head and neck. Br J Plast Surg 1998;51:2-7

45. Brown DH, Mulholland S, Yoo JHH, et al. Internal jugular vein thrombosis following modified neck dissection: implications for head and neck reconstruction. Head Neck 1998;20:169-174

46. Leontsinis TG, Currie AR, Mannell A. Internal jugular vein thrombosis following functional neck dissection. Laryngoscope 1995;105:169-173

47. Blackwell KE, Brown MR, Gonzalez D. Overcoming the learning curve in microvascular head and neck reconstruction. Arch Otolaryngol Head Neck Surg 1997;123:1332-1335

The Role of Free Flaps in Head and Neck Reconstruction

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