Complications of Head and Neck Reconstruction and Their Treatment

ABSTRACT

Head and neck reconstruction is an intensive multistep process that requires attention to detail to achieve a successful result. The knowledge and prevention of complications as well as their management is an essential part of the training of the surgeon participating in head and neck reconstruction. This article explores the general complications, including free flap failure, carotid artery blowout, hardware exposure, and ectropion, as well as regional complications relating to operations of the scalp, cranium, base of skull, midface, mandible, and pharyngoesophagus.

KEYWORDS

Free flap failure - carotid blowout - hardware exposure - ectropion - scalp - cranium - base of skull - midface - mandible - pharyngoesophagus

REFERENCES

• 1 Gurtner G C, Evans G R. Advances in head and neck reconstruction.  Plast Reconstr Surg. 2000;  106 672-682; quiz 683
• 2 Mardini S, Wei F C, Salgado C J, Chen H C. Reconstruction of the reconstructive ladder.  Plast Reconstr Surg. 2005;  115 2174
• 3 Wei F C, Demirkan F, Chen H C et al.. The outcome of failed free flaps in head and neck and extremity reconstruction: what is next in the reconstructive ladder?.  Plast Reconstr Surg. 2001;  108 1154-1160 discussion 1161-1162
• 4 Singh B, Cordeiro P G, Santamaria E, Shaha A R, Pfister D G, Shah J P. Factors associated with complications in microvascular reconstruction of head and neck defects.  Plast Reconstr Surg. 1999;  103 403-411
• 5 Coskunfirat O K, Chen H C, Spanio S, Tang Y B. The safety of microvascular free tissue transfer in the elderly population.  Plast Reconstr Surg. 2005;  115 771-775
• 6 Malata C M, Cooter R D, Batchelor A G, Simpson K H, Browning F S, Kay S P. Microvascular free-tissue transfers in elderly patients: the leeds experience.  Plast Reconstr Surg. 1996;  98 1234-1241
• 7 Harii K. Technical advances of plastic and reconstructive surgery in cancer surgery.  Int J Clin Oncol. 2005;  10 215-217
• 8 Novakovic D, Patel R S, Goldstein D P, Gullane P J. Salvage of failed free flaps used in head and neck reconstruction.  Head Neck Oncol. 2009;  1 33
• 9 Khoo C T, Bailey B N. The behaviour of free muscle and musculocutaneous flaps after early loss of axial blood supply.  Br J Plast Surg. 1982;  35 43-46
• 10 Chen H C, Tan B K, Cheng M H, Chang C H, Tang Y B. Behavior of free jejunal flaps after early disruption of blood supply.  Ann Thorac Surg. 2002;  73 987-989
• 11 Vasilakis V, Patel H D, Chen H C. Head and neck reconstruction using cephalic vein transposition in the vessel-depleted neck.  Microsurgery. 2009;  29 598-602
• 12 Jelks G W, Jelks E B. Prevention of ectropion in reconstruction of facial defects.  Clin Plast Surg. 2001;  28 297-302, viii
• 13 Rohner D, Tan B K, Song C, Yeow V, Hammer B. Repair of composite zygomatico-maxillary defects with free bone grafts and free vascularized tissue transfer.  J Craniomaxillofac Surg. 2001;  29 337-343
• 14 Mustardé J C. The use of flaps in the orbital region.  Plast Reconstr Surg. 1970;  45 146-150
• 15 Kroll S S. Reconstitution of large cheek defects.  Oper Tech Plast Reconstr Surg. 1998;  5 37-49
• 16 Roth D A, Longaker M T, Zide B M. Cheek surface reconstruction: best choices according to zones.  Oper Tech Plast Reconstr Surg. 1998;  5 26-36
• 17 Hamra S T. The deep-plane rhytidectomy.  Plast Reconstr Surg. 1990;  86 53-61 discussion 62-63
• 18 Al-Shunnar B, Manson P N. Cheek reconstruction with laterally based flaps.  Clin Plast Surg. 2001;  28 283-296
• 19 Leedy J E, Janis J E, Rohrich R J. Reconstruction of acquired scalp defects: an algorithmic approach.  Plast Reconstr Surg. 2005;  116 54e-72e
• 20 Lutz B S, Wei F C, Chen H C, Lin C H, Wei C Y. Reconstruction of scalp defects with free flaps in 30 cases.  Br J Plast Surg. 1998;  51 186-190
• 21 Chen T M, Wang H J. Cranioplasty using allogeneic perforated demineralized bone matrix with autogenous bone paste.  Ann Plast Surg. 2002;  49 272-277 discussion 277-279
• 22 Chepeha D B, Wang S J, Marentette L J, Thompson B G, Prince M E, Teknos T N. Radial forearm free tissue transfer reduces complications in salvage skull base surgery.  Otolaryngol Head Neck Surg. 2004;  131 958-963
• 23 Gullane P J, Lipa J E, Novak C B, Neligan P C. Reconstruction of skull base defects.  Clin Plast Surg. 2005;  32 391-399, vii
• 24 Nishizawa S, Yokota N, Yokoyama T et al.. Prevention of postoperative complications in skull base surgery for nasal or paranasal sinus carcinoma invading the skull base.  J Clin Neurosci. 2001;  8(Suppl 1) 67-70
• 25 Neligan P C, Mulholland S, Irish J et al.. Flap selection in cranial base reconstruction.  Plast Reconstr Surg. 1996;  98 1159-1166 discussion 1167-1168
• 26 Georgantopoulou A, Hodgkinson P D, Gerber C J. Cranial-base surgery: a reconstructive algorithm.  Br J Plast Surg. 2003;  56 10-13
• 27 Nameki H, Kato T, Nameki I, Ajimi Y. Selective reconstructive options for the anterior skull base.  Int J Clin Oncol. 2005;  10 223-228
• 28 Archibald S, Jackson S, Thoma A. Paranasal sinus and midfacial reconstruction.  Clin Plast Surg. 2005;  32 309-325, v
• 29 Hidalgo D A. Three-dimensional mandibular reconstruction with vascularized bone grafts. In: Yaremchuk MJ, Gruss J, Manson PN Rigid Fixation of the Craniomaxillofacial Skeleton. Boston, MA; Butterworth-Heinemann 1992: 637-647
• 30 Schmoker R R. Management of infected fractures and nonunions of the mandible. In: Yaremchuk MJ, Gruss J, Manson PN Rigid Fixation of the Craniomaxillofacial Skeleton. Boston, MA; Butterworth-Heinemann 1992: 233-244
• 31 Sakai K, Doi K, Kawai S. Free vascularized thin corticoperiosteal graft.  Plast Reconstr Surg. 1991;  87 290-298
• 32 Celik N, Wei F C, Chen H C et al.. Osteoradionecrosis of the mandible after oromandibular cancer surgery.  Plast Reconstr Surg. 2002;  109 1875-1881
• 33 Disa J J, Cordeiro P G. Reconstruction of the hypopharynx and cervical esophagus.  Clin Plast Surg. 2001;  28 349-360
• 34 Tsao C K, Chen H C, Chuang C C, Chen H T, Mardini S, Coskunfirat K. Adequate venous drainage: the most critical factor for a successful free jejunal transfer.  Ann Plast Surg. 2004;  53 229-234
• 35 Disa J J, Cordeiro P G, Hidalgo D A. Efficacy of conventional monitoring techniques in free tissue transfer: an 11-year experience in 750 consecutive cases.  Plast Reconstr Surg. 1999;  104 97-101
• 36 Chen H C, Tang Y B, Chang M H. Reconstruction of the voice after laryngectomy.  Clin Plast Surg. 2001;  28 389-402