Challenges in multi-unit reconstruction: a framework perspective

Abstract

Locally advanced or recurrent head and neck cancer can present both oncologic and reconstructive challenges. There are no current guidelines for reconstruction of multi-unit defects, yet reconstructive goals should serve the purpose of providing a safe healing environment for both adjuvant therapy and functional rehabilitation. In light of a younger head and neck cancer population, reconstructive methods aimed at preserving form and function over a long survivorship period are optimal. The review of the literature regarding use of single or double free flaps, with or without locoregional reconstructive options, and new techniques for multi-unit defects is described. Managing complex defects with multiple units involves determining a framework of critical, optimal, and optional elements for each reconstruction with consideration of the medical tolerance of the patient and long-term functional rehabilitation. Multi-unit reconstruction should involve distinction of critical, optimal, and optional aspects to provide a safe healing environment for both adjuvant therapy and functional rehabilitation fit for long-term survivorship.