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Minerva Chirurgica 2004 August;59(4):379-86

language: Italian

500 reconstructive flaps in oncological surgery of the head and neck: critical review of 10 years experience

Pompei S., Arelli F.


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Aim. Oncologic surgery of the head and neck, according to the principle of oncological radicality, involves large demolition often including skin, soft tissues and bone structures. The aim of this study is to provide a high-level perspective of results achieved in terms of functionality and softness with the different reconstructive techniques during the last ten years.
Methods. The test group was composed of 467 patients, hospitalised in the ''Regina Elena'' National Cancer Institute in Rome and treated for head and neck cancer; 86% of the treated patients suffered from stage III or IV of the disease. For the reconstructive phase, 506 flaps were used, 45.5% were myocutaneous flaps, 37.1% cutaneous and fasciocutaneous flaps and 17.4% free flaps. Ischemic complications occurred in 5.2% of the myocutaneous flaps group and in 10.3% of the free flaps group.
Results. ''Minor complications'' affected 3.9% of the cases in the free flaps group and 20.8% of cases in the myocutaneous flaps group.
Conclusion. The analysis of the results shows that generally free flaps are more reliable than myocutaneous flaps in terms of minor complications, however they tend to prolong the patient's hospitalisation and increase the overall treatment cost. Furthermore in morpho-functional terms, free flaps ensure results, in defined anatomical areas (such as the cervical-esophageal region, jaw, tongue) that today cannot be compared to the ''conventional'' procedures. As for myocutaneous and cutaneous/ fasciocutaneous flaps, according to personal opinion they are still the first choice for reconstruction having minimal or no functional implications.

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