Refinements and restoring contour in head and neck reconstruction

To date head and neck reconstructions of oncological defects have concentrated on primarily filling the defect to achieve primary wound healing, secondly restore function and lastly cosmesis. This paper describes a refinement of existing free tissue transfer techniques for improvement of contour, function and aesthetics.

A retrospective review of 38 patients operated on by one surgeon at St Vincent's, Royal Melbourne and Western Hospitals over a 3-year period was conducted. Data were collected on patient demographics, tumour details, nature of the defect, type of reconstructive procedure, nature of additional tissue used, radiotherapy, complications and outcome.

We present refinements in using de-epithelialized skin paddles, flexor hallucis longus, and rectus and vastus lateralis muscle in order to achieve optimal reconstruction. Free tissue transfer refinements are discussed in anterolateral thigh, fibula, rectus and anteromedial thigh free flaps. The average defect size and volume of neck dissection prior to reconstruction is presented. A variation of radical, modified radical and selective neck dissections were required for oncological staging and clearance. Rare and minor associated complications are discussed. Post-operative radiotherapy treatment was used in the majority of patients with preoperative adjuvant therapy required in some salvage cases. All patients achieved primary wound healing post-operatively with no salivary leaks, flap failures or exposure of neck vessels.

Supplementary microsurgical tissue transfer of de-epithelialized skin, vastus lateralis, flexor hallucis longus and rectus muscles is a valuable option for restoring contour, aesthetics and vessel protection post-radiotherapy.