Total Defects Of The Hypopharynx And Cervical Esophagus

Reconstruction of total defects involving the hypopharynx and cervical esophagus is an example of free flaps that have proved clearly advantageous over other approaches. Regional skin flaps can be used for total pharyngocervical esophageal defects. However, they require multiple stages to complete and are subject to

Mandibular reconstruction is another area in which the free flaps provide enhanced capabilities versus alternative reconstructive techniques. A vascularized osseous, osseocutaneous, or osseomyocutaneous free flap has a distinct advantage in primary reconstruction of mandibular defects. The free flaps have a higher rate of success compared with nonvascularized bone grafts in primary reconstruction. Mandibular plate reconstruction without bone is always an option. We prefer to use plates for lateral defects. Anterior defects and larger defects are associated with a higher rate of complications, and vascularized flaps are favored in this setting.34

Mandibular reconstruction has been and continues to be one of the major challenges facing the otolaryngologist-head and neck surgeon. A variety of free flaps have been described for mandibular reconstruction. The most popular include transfer of portions of the scapula, iliac crest, and fibula.35-39 Fibular free flaps have emerged as the most common technique. This technique has minimal donor site morbidity, and the bone provides the rigidity necessary to maintain soft tissue in the appropriate position. Any type of vascularized bone free flap transfer also provides the opportunity for either primary or secondary insertion of osseointegrated implants that enable denture application. There is conflicting information about whether these types of mandibular reconstruction dramatically restore chewing function of a normal mandible.40-42 It may be that mandibular reconstruction with free flaps may provide more of a cosmetic than a functional benefit.

Regional pericranial flaps coupled with calvarial bone grafts and skin grafts appear to be sufficient to seal the intracranial cavity in a one-stage procedure in the majority of instances. In specialized instances, free flaps are used when a cranial base defect is coupled with a large facial bony and soft tissue defect created by the resection of a large malignancy.

0 0

Post a comment