A standardized grading scale for reconstructive process surgery in head and neck cancer.

Abstract

e16000 Background: Following carcinologic operative step, head and neck cancer surgery requires a reconstructive step involving local or regional, pedicled or free flaps. Although the reconstructive technique specifics depend mainly on the surgical team, the functional goal is so important that the best choice should be fully understood and discussed by the multidisciplinary team, including all involved medical staff. At the present time, the too numerous reconstructive procedures explain the great difficulty in including surgical reconstructive treatments in head and neck cancer prospective international studies, particularly in functional and quality of life evaluation. Methods: We have retrospectively established this scale in head and neck reconstructive surgery, based on 197 pedicled flaps and 225 free flaps performed from 2004 to 2008. Results: Therefore, we are proposing the Poissonville 2009 grading scale (Table), gathering the various head and neck reconstructive procedures according to the surgical difficulty and duration. It can be easily applied to any head and neck anatomical area. Conclusions: This scale is aiming at including the reconstructive step within the existing therapeutic guidelines, allowing the inclusion of the patient's medical condition and functional requirements in the therapeutic choice. Moreover, the cost effectiveness of the surgery could be evaluated by this scale according to the surgical procedure as others cancer staging classifications. Standardized grading scale of flaps for head and neck reconstructive surgery (Poissonville 2009) S type Without flap Direct suture, healing, skin graft M type Local pedicled flaps FAMM, myocutaneous buccinator, nasolabial L type Regional head and neck pedicled flaps Platysma, infrahyoid myocutaneous, temporoparietal fascia XL type Beyond head and neck area pedicled flaps Myocutaneous pectoralis major, myocutaneous latissimus dorsi XXL type Free flaps with microvascular surgery NB(no bone) Fasciocutaneous or myocutaneous flaps Radial forearm, anterolateral thigh, lateral arm, scapular, latissimus dorsi B(bone) Osteocutaneous flaps Fibular, scapular, iliac crest D Digestive flaps Digestive Jejunal, gastro-omental No significant financial relationships to disclose.