Operative treatment of head and neck cancers can often result in impairment of swallowing, speech, respiration and appearance. Alongside control of the disease, rehabilitation is an essential goal of treatment. Reconstruction, often in the form of flap surgery, aims to restore form and function for rehabilitation.
Flap surgery refers to the transfer of tissue, with its blood supply, from a healthy part of the body (donor site) to the defect (recipient site). Flaps can be categorized into local, regional and free flaps.
The need for regional reconstruction depends on the patient's exact diagnosis and condition. A regional flap might be used in a number of situations, for example:
A regional flap reconstruction is conducted when tissue is transferred from a part of the body in or near the head and neck region and rotated into the surgical defect. The blood supply to the flap is left attached, and the flap of skin and/or muscle is simply rotated with the blood supply as a pedicle. This does not require removing the flap entirely from the body prior to transplantation, which is what is required in performing a free flap.
Advantages of a regional flap are that post-operative care and monitoring are much less intense compared with a free flap. Regional reconstructive surgeries are usually shorter than those required for a free flap. Large amounts of skin and/or muscle can be obtained.
The disadvantages of regional reconstruction include the fact that the flap must remain tethered on its blood supply. Therefore, there may be difficulty reaching the entire defect. There may also be less flexibility in thickness of the flap, compared with a range of available free flaps that can be brought up from all over the body.
Regional flaps used in head and neck surgery include: