Secondary Reconstruction in Head and Neck Cancer

Secondary reconstruction in head and neck cancer refers to surgical procedures performed following the initial primary reconstruction to address complications, residual defects, or recurrent or second primary tumors. The timing of secondary reconstruction can be categorized as either immediate or delayed. Immediate reconstruction is typically required in cases of flap failure or acute complications such as fistula or great vessel exposure. In contrast, delayed reconstruction addresses long-term sequelae such as trismus, oral incompetence, and mandibular or maxillary defects, as well as late complications including plate exposure and osteoradionecrosis (ORN). The interval between initial treatment and secondary reconstruction may range from several months to several years, depending on the clinical condition and patient preference. Thorough planning and appropriate patient selection are critical for optimal functional and aesthetic outcomes. This article focuses on conditions commonly encountered in delayed secondary reconstruction; immediate reconstruction is covered elsewhere.