Nidal Farhan Al Deek

Fistulae After Successful Free Tissue Transfer to Head and Neck Its Prevention and Treatment

Fistulas, either between oral cavity and external face or between oral and nasal cavity, are major complications after microsurgical head and neck reconstruction. Any flaw in surgical planning, design, and execution may lead to this untoward outcome. Once fistula develops, it may interface with oncologic treatment, endanger the reconstruction, and increase overall patient suffering. This article analyzes individual factors involved in development of fistulas in spite of successful transfer of a free flap and proposes treatment guideline.

Free Tissue Transfer to Head and Neck: Lessons Learned from Unfavorable Results-Experience per Subsite.

This article provides a lesson-learned approach per site and anatomic structure to head and neck reconstruction. It addresses the most common unfavorable results following successful free flap transfer shedding light on why they happen and how to prevent them. It draws from hundreds of advanced and complicated microsurgical head and neck reconstruction cases, aiming to achieve excellence in the reconstructive endeavor and to enhance the patients quality of life.

The Osteosarcoradionecrosis as an Unfavorable Result Following Head and Neck Tumor Ablation and Microsurgical Reconstruction

Osteoradionecrosis is preferably called osteosarcoradionecrosis to adequately cover the scope of the problem: multitissue necrosis. The changes following radiotherapy and leading to necrosis are further classified into 2 phases based on improved understanding of the underlying mechanisms. The reversible-damage phase could respond to the medical treatment, while the irreversible damage phase or osteosarcoradionecrosis may benefit from complete resection and free flap reconstruction. The role of ablation and reconstruction in paving the road for the development of osteosarcoradionecrosis is discussed, a case study provided, and a refined reconstructive approach proposed.

The Battle Ground between Two Giants: Toe Transfer and Hand Allotransplantation

A few severe hand injuries represent a gray zone for the reconstructive surgeon, for which autologous tissue transfer and allotransplantation can yield satisfactory results, but not without downsides or morbidity.This article is written to address the dilemma of application of both techniques in those selected cases.

The Unfavorable Outcome: Here We Conquer

ni cs .c om Microsurgical reconstruction of the head and neck defects is the gold standard of treatment. Success rates are in the region of 98% in most of the major referral centers. Traditionally, success is defined by the patency of microvascular anastomosis and free flap viability. However, as we grow more critical about our success, its definition has evolved to refer to the successful restoration of function and appearance with improved patient quality of life. Achieving a successful reconstruction beyond flap survival is, therefore, a challenging, experience-demanding endeavor that necessitates a comprehensive understanding of the unfavorable outcomes. This includes why and how they happen as well as strategies to avoid and manage them. Information on the unfavorable outcomes after a microsurgical head and neck reconstruction gone wrong despite successful free flap surgery is lacking. The paucity of information in the literature is the impetus for this special issue of Clinics in Plastic Surgery. Our aim is to provide an immense, experience-based reflection with sincere accounts from the experts on the unfavorable outcomes after microsurgical reconstruction of the head and neck. And, our hope is that this work will help guide surgeons to achieve success in restoring human dignity with good function and aesthetics.