Keynote Address VI: The evolution and limitations of current approaches to autologous reconstruction of the head and neck: A personal perspective and a look forward

Abstract

The goal of all reconstruction is the restoration to normal form and function. Nowhere is this more difficult than in the head and neck especially after major extirpative procedures. There is a lack of ‘like tissues’ available locally, and usually autologous tissue needs to be transported from a distance to achieve wound closure. However the initial outcome often falls well short of the stated goal of ‘restoration to normal form and function’. The reconstructive process commences with an accurate diagnosis of the deformity and appraisal of the missing part(s). The surgeon then needs to be familiar with the full spectrum of reconstructive options and select the method of reconstruction that will give the best outcome. This takes meticulous technique and planning, and the optimal strategy may involve multiple modalities of treatment and/or multiple staged procedures. One must take special care not to burn bridges and compromise the final result. The options available to the reconstructive surgeon have increased greatly over the last 30 years. With the larger number of flaps available, there is now an expansive choice, and the emphasis has shifted to better flap selection and refinements. The focus of the presentation will be to describe the current techniques available to reconstruct facial contour deformities, facial resurfacing after burn injury and tumor extirpation, and in complex defects, the use of folded flaps, multifaceted and laminated flaps, prelaminated and prefabricated flaps. However we still a need to distinguish between “Restoration” (which can only be achieved with reattachment of severed parts) and “Reconstruction”, which unfortunately will always be well short of the restorative result if the lost part could have been replanted – this is despite the utilization of every rung of the reconstructive ladder and multiple stages to obtain a maximum aesthetic result. Furthermore, as we are about to enter a new era of composite tissue transplantation, this presentation will also critique and contrast the aesthetic and functional results that are achievable in the head and neck utilizing the full spectrum of reconstructive options and compare these with what has been achieved in the few partial and full facial transplantation cases that have been performed to date.