This document discusses various reconstructive surgery options for restoring form and function after defects in the head and neck region. It outlines a reconstructive ladder ranging from primary closure and skin grafts for small defects, to local and regional flaps, myocutaneous flaps, and free flaps for more complex reconstructions. Key flaps discussed include the pectoralis major flap, fibula flap, radial forearm flap, and anterolateral thigh flap. Patient factors, defect characteristics, and the goal of restoring oral competence, speech, and swallowing are considered in surgical planning. The conclusion emphasizes that reconstructive surgery is essential for improving head and neck cancer survivors' quality of life.

2. RECONSTRUCTIVE SURGERIES
Aim : Restoration of form and function
Form:
cosmetic
Restoration of contour
Expression of face
Oral competence
Functions:
Speech
Mastication
Deglutition

3. Reconstructive ladder
It consists of following steps starting from simplest to
most complex
Primary closure
Skin grafting
Local flaps
Regional flaps
Distant flaps
Free flaps

4. Patient selection and decision making
 Select the most appropriate option for the particular
defect
 Patient factors-Age,perfomance
status,comorbidities
 Patient choice and expectations
 Tissues to be replaced
 Occupation
 Patient counselling

5. Primary closure
 Small and moderate
defects of
 Skin
 Soft tissues
 Mucosa
 Should not cause
 Restriction of
movements
 Tension
 Cosmetic disfigurement

6. Skin grafts
For small and superficial
defects of skin and mucosa
Split thickness skin graft
Full thickness skin
grafts

7. Full thickness skin grafts
Ideal for covering small defects
after removal of tumours in areas
like
1. Tip of nose
2. Parts of the pinna
3. Lower eye lid.
Limitation of skin graft:
Colour mismatch,
contour irregularity,
graft contracture

8. Locoregional flaps
Local Flap:
skin flap taken from an
area close to the wound.
E.g.
Abbe transoral cross – Lip flap
A wound on the lip may be
repaired by a flap from the
adjacent cheek.
Eslander flap
Bernad –Burrow flap

9. Local Flaps features:
 Rich Vascularity
 Lot of local flaps available
 Long and thin local flaps can be planned
 Good colour and texture match
 Good healing of donor site
 Less morbidity
 Same incision & field
 Little expertise
 Time saving

10. Regional Flap:
Skin flap is not from the
adjacent area, but is from
the same region of the body.
e.g
Nasolabial flaps
Forehead flaps
Cervical flaps
Submental flaps

11. Submental artery Island Flap
This is an axial pattern flap based on the
submental branch of the facial artery
Advantages:
 The donor site scar is hidden
under the mandible.
 Flap has a large and reliable
vascular pedicle with excellent
reach to most of the oral cavity.
 Ideal thickness for
reconstructing buccal mucosa
and tongue defects.
 Less bulk and less time
consuming when compared with
free flaps

12. Disadvantages:
Submental flap harvested with
a thick surrounding fibrofatty
tissue and tissues around the
facial vessels can compromise
the lymphatic clearance. So it
is better to avoid this flap in
patients with clinically
significant node in level IA
and IB.

13. DELTOPECTORAL FLAP
It served as the premier flap for
reconstructing complex head and
neck defects LIKE oral
cavity&cheek
Advantages
 Technical simplicity
 Predictable vascular supply
 The DP flap also provides a
valuable salvage option
The deltopectoral flap is based on
perforators from the internal mammary
artery, usually perforators passing
through the second and third intercostal
spaces.

14. Myocutaneous Flaps
• Commonest reconstructive option for major head
and neck defects
 Pectoralis major flaps
 Sternomastoid flaps
 Trapezius myocutaneous flaps
 Latissimuss dorsi flaps

15. Pectoralis major myocutaneous flap
The most frequently used
myocutaneous flap
The workhorse of the head
and neck surgeon
The blood supply to
pectoralis major flap is consistent
and so very reliable.
The donor defect can be
closed primarily in majority of
cases.

16. Main uses of Pectoralis major
Myocutaneous flap
o For reconstruction of major intra oral
lining defects
o For reconstructing outside skin defects
of cheek or full thickness defects of oral
cavity.
o For covering major neck skin defects
following extended radical neck dissection
and in post irradiated patients.

17. o For protecting the exposed carotid vessels following neck
dissection to prevent carotid blow out.
o For augmenting the pharyngeal closure following
laryngopharyngectomy when there is tension in pharyngeal closure
especially in salvage set up.
o For reconstructing circumferential pharyngeal and cervical
oesophageal defects.

18. Platysma flap
Ideal for reconstructing the
superficial lining defects of oral cavity
Disadvantages
 Blood supply can be unreliable.
 Prior neck dissection or any neck
surgeries precludes the use of this flap
 Improper neck dissection may damage
the blood supply to the flap
 Removal of the platysma interferes with
the blood supply lead to necrosis of skin.
 Platysma flap is not advisable in
patients with prior irradiation to neck.

19. Sternomastoid flap
Advantages
 The skin is hairless and thin
 An ideal reconstructive option for medium sized cheek
defects.
 It does not produce excessive bulk in the face or mouth
Disadvantages
 Improper neck dissection is likely to cause damage to
the vascular pedicle.
 A previous neck surgery or concurrent
lymphadenectomy preclude the use of this flap

20. Trapezius Myocutaneous Flap
It is used for
reconstructing defects of
head and neck region
and upper back.
Its location makes it
the flap of choice for
defects of the occipital,
parotid and cervical
spine regions.

21. Free Flaps
Features
 Pliable so as not to impair
movement in head and neck
 Consistent, large and long
pedicle
 Possibility of variable size
& thickness
e.g
Radial Forearm flap
Antero lateral Thigh flap
Free Fibula flap
Latissimus Dorsi flap
DCIA flap
TRAM flap

22. MANDIBULAR RECONSTRUCTION
FIBULA FLAP
It consists of the fibula
bone & soft tissues
ADVANTAGES
25 cm of fibula can be
harvested
Extensive periosteal
vascular supply allows
functional reconstruction of the
mandibule
Others
Iliac crest flap
scapular flap

23. CONCLUSION
Reconstructive surgery is an essential part of head and
neck cancer surgery
This improves the form and function of survivors and the
quality of life.
Various options are available for head and neck
reconstructions and has to select the appropriate one

24. Thank you
THANK YOU