Medical Management of the Surgical Patient

Reconstruction of head and neck defects following cancer ablation presents a difficult challenge to the reconstructive surgeon. The upper aerodigestive system serves multiple important functions such as speech, swallowing, respiration, and protection of the airway that reconstruction must attempt to preserve in both form and function. During surgery, the normal anatomy of this system is disrupted and can impair all of these functions. The goal of reconstruction is to recreate the normal anatomy as best as possible in order to maintain function and decrease morbidity following cancer ablation, while taking into consideration aesthetics, body image and quality of life of the patient.

Multiple techniques for reconstruction are available. These include primary closure, skin grafting, local-regional flaps, pedicled fasciocutaneous or myocutaneous flaps, and free tissue transfer flaps. Each type of flap has a vascular pedicle supplying the tissue; a free tissue transfer will require microvascular anastamosis of this pedicle to local recipient vessels. Patients must be rigorously evaluated preoperatively to define the lesion and the anticipated defect, as well as to determine the best options for reconstruction. The reconstructive surgeon must have multiple options available prior to initiating cancer resection, as the final defect often cannot be determined until the lesion has been removed and all margins are free of cancer.