ABSTRACT
Despite the advances in head and neck reconstruction, complications and suboptimal
reconstructions continue to exist. Soft tissue contraction, failure of a previous
reconstruction, and resection of a recurrent tumor all result in a “recurring” defect.
A successful reconstruction in these patients requires a detailed knowledge of the
patient's history and the details of the previous reconstructive attempts and discussions
with the patient and the patient's family to come to terms with realistic goals. As
many of these patients have already received radiation therapy and have also exhausted
some of the reconstructive flap options and recipient vessels that could be used,
the surgeon is faced with the challenge of selecting the best reconstructive method
and the optimal timing of reconstruction in these cases. Simple methods of reconstruction
can occasionally suffice in completing the reconstruction; however, if the same indications
exist and a free flap was performed in the previous setting, usually another flap
of the same quality is required to achieve an optimal result in these cases. Patients'
characteristics, methods of reconstruction, optimal timing for reconstruction, flap
options, and choice of recipient vessels are discussed.
KEYWORDS
Head and neck reconstruction - complications - recurrent defect - multiple reconstructions
- free flap reconstruction
