Preoperative Planning in the Reconstruction of Post-oncologic Head and Neck Defects

Abstract

In head and neck reconstructive procedure, the type of reconstruction selected should be tailored to the defect in order to achieve an optimal functional and aesthetic result. It is important to choose a reconstructive strategy that not only is tailored to the defect but also the patient. We know that a large proportion of patients presenting with head and neck cancer are the elderly with multiple co-morbidities, and therefore the decision-making process with regard to flap selection must take these patient-related factors into account, in order to minimize morbidity. Preoperative planning in the reconstruction of head and neck defects could be based on an emphasis on tumour-related and patient-related factors and how these can help us select the most appropriate reconstructive option for our patients. 1. Tumour-related factors relating to the site and stage of the primary tumour guide the surgeon in the initial preoperative planning of the likely reconstruction required. 2. Systemic and local patient-related factors such as relevant co-morbidities and previous radiotherapy must be considered at the planning stage in order to minimize preoperative risk and ensure that the most suitable reconstruction is selected. 3. Defect analysis allows the surgeon to classify the post-resection deficit into simple, complex or composite defects, which can then be reconstructed based upon the required tissue components. 4. By using the workhorse flap options such as anterolateral thigh flap, fibula osteocutaneous flap and radial forearm flap, most defects of the head and neck can be reconstructed, achieving favourable functional and aesthetic outcomes.