Reconstruçã o de defeito cirúrgico com retalho livre microvascularizado por otorrinolaringologistas

Abstract

Introduction: The reconstruction of surgical defects after tumor resection in head and neck oncological surgery uses various techniques, which should preferably be performed at the same time. At the top of the so-called “Reconstructive ladder” are the Microvascular free flaps. Usually performed by plastic surgeons, any obstacle to their access should not preclude other surgeons, working in the field of head and neck surgery, the ability to offer their patients this type of reconstruction. Thus, one can see increasingly, the mastery of these techniques by surgeons with different training areas, including otolaryngologists. Methods: Clinical case report and literature review Results: We present the case of a 47-year-old patient with a squamous-cell carcinoma of the left tonsil (pT2N2b) to whom we proposed a partial pharyngectomy with reconstruction with radial forearm free flap. Two senior surgeons of the ENT Department of the IPOLFG (Portuguese Oncological Institute at Lisbon) with extensive experience in oncological head and neck surgery, but without experience as primary surgeons in microvascular reconstruction, developed a prior preparation program that included training sessions with cadaver forearm free flap raising and vascular anastomosis in laboratory rats. The surgery was performed in September 2011 with chemoradiotherapy in November and December 2011 and with good viability of the flap to date and good functional results. Conclusions: With proper training and preparation, reconstruction with microvascular free flaps can (and should) be achieved by otolaryngologists dedicated to head an neck surgery