Dott.re Giuseppe Spinelli

Post-oncological reconstruction

POST-ONCOLOGICAL RECONSTRUCTION

Reconstructive Surgery

Often in the case of malignant tumors of the head and neck it is necessary the use of extensive demolition of the skeleton portions of the facial soft tissues.

Immediate reconstruction is indicated, which is performed during the same tumor removal operation. Sometimes the reconstruction is performed later. The reconstructive options are however the same, whether they are contextual or subsequent to the main intervention. As a school, we prefer to perform immediate reconstruction.

SKIN GRADES

Skin grafts or dermo-epidermal grafts are used for the reconstruction of leaks from small to moderate, often the result of skin tumors of the face (basaliomas or melanomas).

LOCAL FLAP

A local flap consists in the closure of a loss of substance using the tissues surrounding the loss itself. This option is widely used in the event of small or medium-sized leaks of the face, often as a result of skin cancers (epitheliomas).

PEDUNCULATED FLAPS

A pedunculated flap involves the transfer of a portion of tissue nourished by a vascular peduncle that is identified and isolated. The tissues maintain their vitality and draw nourishment from the peduncle until, a few weeks after the operation, new vascular connections with the recipient site are not established. At this point, if indicated, it is possible to proceed to the section of the vascular peduncle, performing what is called “flap autonomization”.

The most used pedunculated flaps are: temporal muscle flap, due to loss of substance in the maxilla or orbit.

Paramedian frontal flap or Indian flap for total or subtotal reconstruction of the nose: in this case the peduncle is cut 3/4 weeks after the primary surgery.

Superclavicular flap for the reconstruction of substance losses (soft tissues) of the lower third of the face.

Infraioid flap, ideal for reconstructing the oral floor or the lower portion of the tongue (lingual pelvis).

The advantage of the pedunculated flaps compared to the revascularized free flaps lies in the greater simplicity of execution, in the lesser total surgical time and in the lower associated morbidities.

BONES GRAFT

Bone grafts are used in the oromaxillofacial district for the reconstruction of bone loss of less than 6 cm. Deficits greater than or equal to 6 cm require the use of revascularized free flaps.

A bone graft involves the placement of autologous, homologous or heterologous bone to fill a loss of substance. The bone acts as a three-dimensional scaffold through which the neo-osteogenetic processes of the recipient site restore lost bone within a few months.

After 4 6 months from the graft it is possible to place osseointegrated implants to position dental prosthetic elements.

LEMBONS RIVASCOLARIZED FREE

A revascularized free flap involves the transfer from a donor site to a tissue receiving site (bone and / or soft parts) together with the vascular pedicle that feeds it, which is detached from the donor vessels and connected to the recipient site vessels through microvascular anastomoses.

This type of surgery allows the transfer of tissue at great distances, thus allowing for large-scale reconstructions, sometimes not possible with the techniques described above.

On the other hand, these operations last many hours (even over 12 hours) and are burdened with a higher number of complications.

THE MOST USED FREE LEMBONS ARE

Osteofasciocutaneous fibula flap, for the reconstruction of losses of bone substance and soft tissues of the mandible or maxilla.

Fasciocutaneous forearm flap, for the reconstruction of soft tissue losses of the oral or partial mucosa of the tongue.

Anterolateral thigh flap for large losses of soft tissue in the head area or subtotal loss of the tongue.

Gran dorsal free flap, for large losses of soft tissue of the craniofacial district.