Flow Chart for Reconstructive Head and Neck Surgery in Composite Soft and Hard Tissue Defects.

ABSTRACT

INTRODUCTION: Virtual planning of reconstructive surgical procedures in patients with osseous and composite defects in the head and neck region is becoming increasingly a state of the art modality. However, computational algorithms lack the capability of planning the involved soft tissue and vascular pedicle position. The authors present a flow-chart to solve this problem in the reconstruction of defects of the upper and lower jaw. MATERIAL AND METHODS: Clinical records from 2013 to 2018 from a tertiary care center were screened for patients undergoing osseous reconstruction in the head and neck region. A flow-chart considering soft tissue positioning and the anatomical course of the vascular pedicle was assessed in consideration of the defect and donor-site. RESULTS: A total of 81 osseous and composite microvascular reconstructive procedures have been conducted. Defects of the lower jaw were the most common (n = 61). The free fibula flap was the most common reconstructive measure and showed a wide versatility of surgical options to reconstruct these defects. The flow charts were assessed accordingly in these procedures. CONCLUSION: Soft tissue and vascular pedicle positioning can be planned pre-operatively by the use of virtual planning and should be considered as an enhancement tool to the already existing computational algorithms of planning hard tissue reconstruction.