Reconstruction of soft-tissue defects in the head and neck is best accomplished using similar composite tissue. In the head and neck, this tissue is usually available in the form of adjacent tissue transfer. The local adjacent tissue resembles the resected tissue in color and composition. In some circumstances, the local tissue is not suitable for transfer. This may be due to previous surgery, exposure to radiation, or a defect that is too large for local tissue transfer. In these cases, free tissue transfer may be needed. Free tissue transfer allows for the replacement of similar composite tissue that has not seen previous treatment. The diversity of sites that may be harvested allows a relatively similar tissue match. This article discusses recent advances in the reconstruction of 3 areas that in the past have presented many problems to the reconstructive surgeon. Total nasal and lip reconstruction have been problematic. In heavily pretreated patients, the reconstruction often results in suboptimal outcomes. Large scalp defects in the setting of previous excisions or irradiation are difficult to reconstruct and rehabilitate. In all of these cases, the ability to transfer composite tissue has improved the functional and cosmetic outcomes.
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Isolated near-total lower lip reconstruction using the Karapandzic flap. A, This patient demonstrates a large lower lip in a previously untreated field. B, A subtotal lower lip resection is performed, and the defect is demonstrated here. C, The postoperative results demonstrate adequate cosmesis and function.
Total lip reconstruction. A, This patient demonstrates a large lower lip lesion that recurred after previous surgical excision. B, A template made of the defect was drawn on the radial forearm tissue before harvest of the free flap. C, The postoperative result demonstrates an adequate functional and cosmetic outcome.
Forehead reconstruction. A, A patient with a large forehead lesion that required almost complete excision of the forehead. B, The operative defect is considerable, and it is not believed to be reconstructable using local flaps. C, A radial forearm free flap was used to reconstruct the forehead, with an acceptable result.
Scalp reconstruction. A, This patient has a large neglected tumor of the scalp. B, A subtotal scalp excision and a near-total forehead excision were performed. C, The defect was reconstructed using a free latissimus dorsi flap with skin grafts.
Nasal reconstruction. A, This patient has had a recurrence of his nasal cancer. He had previous surgical resection and irradiation. B and C, The resection involved most of his nasal structures. B, Anteroposterior view. C, Lateral view.
A facial free flap was harvested. No cutaneous components were included.
View of the free flap being used for the internal lining. It is tacked to the bony strut that is used to reconstruct the nasal dorsum.
The 1-year postoperative photograph shows an acceptable cosmetic and functional result.
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