Flap reconstruction in the head and neck: expected appearance, complications, and recurrent disease

Reconstruction of large head and neck operative beds requires moving tissue from one region to another. These flaps may be rotated to cover a defect with the vascular supply intact, or the vascular supply can be transected and re-anastamosed to vessels in the operative bed. This article will review the types of flaps that have been developed to reconstruct treatment sites in the head and neck, describe the expected findings of a flap, and illustrate the appearance of flap complications, especially recurrent tumor.

Thirty-five patients with flap reconstruction were imaged either as a baseline study, or because of clinical suspicion for recurrent tumor. All patients had undergone resection of squamous cell carcinoma of the head and neck, with flap reconstruction. The computed tomographic (CT) and magnetic resonance (MR) images were retrospectively reviewed, with the clinical history and biopsy results, to determine the imaging findings of recurrent disease.

Recurrent tumor in the resection bed or flap appeared as a focal mass, usually at the interface of the operative site and the flap. Induration of the fat around the flap, or the fat within the flap, was an indirect finding associated with recurrence. Nodal recurrence, either ipsi or contralateral to the primary, was common.

It is important to be aware of the type of flap used to reconstruct head and neck surgical defects. The expected appearance of the flap, and findings associated with recurrent disease are predictable, and are illustrated in the article.