Peter C. Neligan

PREDICTORS OF MORBIDITY FOLLOWING FREE FLAP RECONSTRUCTION FOR CANCER OF THE HEAD AND NECK

Free flap reconstruction of head and neck cancer defects is complex with many factors that influence perioperative complications. The aim was to determine if there was an association between perioperative variables and postoperative outcome.

Morbidity After Flap Reconstruction of Hypopharyngeal Defects

Objectives: Laryngopharyngeal reconstruction continues to challenge in terms of operative morbidity and optimal functional results. The primary aim of this study is to determine whether complications can be predicted on the basis of reconstruction in patients undergoing pharyngectomy for tumors involving the hypopharynx. In addition, we detail a reconstructive algorithm for management of partial and total laryngopharyngectomy defects.

Cutaneous metastatic squamous cell carcinoma to the parotid gland: Analysis and outcome

Our aim was to review the presentation, treatment, and outcome of patients with metastatic cutaneous squamous cell carcinoma involving the parotid gland at a tertiary referral center.

Functional outcomes and donor site morbidity following circumferential pharyngoesophageal reconstruction using an anterolateral thigh flap and salivary bypass tube

This study reports our experience with fasciocutaneous reconstruction of circumferential pharyngoesophageal defects using an anterolateral thigh flap wrapped around a salivary bypass tube.

Primary and salvage (hypo)pharyngectomy: Analysis and outcome

Surgery for squamous cell carcinoma (SCC) arising or extending to the hypopharynx is generally reserved for advanced disease or salvage. The prognosis of patients requiring pharyngectomy is poor, and the perioperative morbidity is significant. The aim of the present study is to describe the disease‐related and treatment‐related outcomes of patients undergoing primary and salvage pharyngectomy for cancer of the hypopharynx and larynx over a 10‐year period from a single institution.

Head and neck reconstruction with anterolateral thigh flap.

OBJECTIVEnOur goal was to present our experience with the free anterolateral thigh flap for reconstruction of various cutaneous and mucosal defects of the head and neck.nnnSTUDY DESIGNnWe conducted a retrospective review of 37 patients who underwent reconstruction between 1994 and 2002. Outcome measures included ethnicity, flap harvest technique, vascular anatomy, flap success, general surgical complications, and donor site morbidity.nnnRESULTSnThe majority of our patients were white (n = 33). The size of the 39 free anterolateral thigh flaps varied from 24 to 252 cm(2). There was 1 arterial failure and flap loss (2.6%) and 2 venous occlusions that were both salvaged. The donor site was closed primarily in 37 cases and with a split-thickness skin graft in 2 cases.nnnCONCLUSIONSnThis is the first report on using the free anterolateral thigh flap in whites. This free transfer has proved to be a versatile and reliable flap for reconstruction of the head and neck.

TEN-YEAR EXPERIENCE OF FREE FLAPS IN HEAD AND NECK SURGERY. HOW NECESSARY IS A SECOND VENOUS ANASTOMOSIS?

Successful free flap surgery in the head and neck is dependent on the successful anastomosis of both artery and vein. The success of all free flaps was analyzed to determine the necessity for performing 2 venous anastomoses.

Second free flaps in head and neck reconstruction

INTRODUCTIONnAblative surgery for head and neck cancer often results in defects that require free flap reconstruction. Improved survival after refined oncologic and adjuvant techniques has led to an increase in the number of patients undergoing a second free flap reconstruction. The objective of this study was to assess outcomes following a second free flap in head and neck reconstruction.nnnMATERIALS AND METHODSnFollowing ablative defects in the head and neck, 1475 patients underwent reconstructive surgery over a period of 17 years. A second free flap for reconstruction was performed on 123 of these patients. In Group 1, 93 patients had a reconstruction for either tumour recurrence, second primary tumour or reconstructive complications (fractured plate, osteoradionecrosis, orocutaneous fistula). In Group 2, 30 patients had a second free flap following primary free flap reconstructive failure.nnnRESULTSnFlap success for Group 1 patients was 86/90 (96%) compared to group 2 patients, 22/30 (73%) (p < 0.05). In Group 1, partial necrosis occurred in four patients whereas in Group 2, there was only one partial necrosis (NS; p > 0.05).nnnCONCLUSIONnA second free flap may be required for reconstruction of head and neck defects following complications of the initial reconstruction, presence of a second primary or tumour recurrence. Success rates for second free flap reconstructions were significantly lower in those patients with initial free flap failure.

Patient satisfaction following nipple reconstruction incorporating autologous costal cartilage.

BACKGROUNDnNipple-areolar reconstruction completes post-mastectomy breast reconstruction. Many techniques for nipple reconstruction have been described, and each has their advocates and critics. One of the frequent failings of most designs is loss of nipple projection with time.nnnOBJECTIVESnTo determine the effect of including autologous costal cartilage on patient satisfaction with their nipple reconstruction.nnnMETHODSnSixty-eight patients were identified who had undergone fishtail flap nipple reconstruction following autologous free flap breast reconstruction between 1990 and 2004. Qualitative questionnaires, using Likert scales, were sent to each patient to specifically assess their satisfaction with their nipple reconstruction.nnnRESULTSnOf 26 respondents (mean +/- SEM follow-up period 3.7+/-3.6 years), 13 had undergone nipple reconstruction incorporating costal cartilage banked at the time of initial breast reconstruction, and the other 13 had no cartilage in their nipple reconstructions. While both groups would opt for nipple reconstruction again, patients with cartilage grafts incorporated into their reconstructions had overall satisfaction ratings 1.92 grades higher on average (not significant, P=0.12) than those without. This difference increased to 3.2 grades when the satisfaction of the patients partner was taken into account (P<0.05). Improved satisfaction corresponded to higher scores for volume, consistency, texture, and particularly for projection and contour of the nipple (P<0.05). Although nipple morphology changed over time, there was a trend toward improved stability in the cartilage group.nnnCONCLUSIONSnPatient satisfaction with nipple reconstruction can be improved by incorporating costal cartilage beneath the skin flaps. Superior contour and projection are sustained over time.

Bilateral latissimus dorsi flaps for the reconstruction of extensive scalp defects

BACKGROUNDnThe reconstruction of large scalp defects is occasionally required. Several methods of scalp reconstruction have previously been described. This paper presents the authors experience with two patients in whom traditional methods were not sufficient and in whom bilateral latissimus dorsi free flaps were required.nnnOBJECTIVESnTo evaluate the effectiveness of a new technique in reconstructing extensive scalp defects.nnnMETHODSnTwo case histories are presented. These include the rationale for the choice of reconstruction used as well as a discussion on the technical features of the surgery.nnnRESULTSnReconstruction was effective in both cases. However, one patient died in the early postoperative period from a pulmonary embolus.nnnCONCLUSIONSnBilateral latissimus flaps can be safely and effectively used in closing massive scalp defects in selected cases.