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 Table of Contents  
GUEST EDITORIAL
Year : 2020  |  Volume : 8  |  Issue : 1  |  Page : 1-2

Reconstruction in head and neck cancer surgery: The ways we came through and the path ahead


Department of Head and Neck Oncology and Reconstructive Surgery, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham, Kochi, Kerala, India

Date of Submission06-Mar-2020
Date of Acceptance06-Mar-2020
Date of Web Publication18-Jun-2020

Correspondence Address:
Subramania Iyer
Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham, Kochi, Kerala
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jhnps.jhnps_24_20

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How to cite this article:
Iyer S. Reconstruction in head and neck cancer surgery: The ways we came through and the path ahead. J Head Neck Physicians Surg 2020;8:1-2

How to cite this URL:
Iyer S. Reconstruction in head and neck cancer surgery: The ways we came through and the path ahead. J Head Neck Physicians Surg [serial online] 2020 [cited 2020 Sep 20];8:1-2. Available from: http://www.jhnps.org/text.asp?2020/8/1/1/287153



Management of head and neck cancers is one of the areas where dramatic changes influencing patient-related outcomes both in quantity and quality of cure have occurred in the past few decades. This became possible due to collective thinking and advances seen in the different subspecialties involved in the management of these cancers, namely medical, radiation, and surgical oncology. The prime aim of preservation of organs and their functions has been the hallmark of these multidisciplinary efforts. The surgical oncology practice has been evolving to offer organ preservation as well as functional rehabilitation through reconstructive surgery. This happened due to the fusion of advances in instrumentation and technology with the surgical innovativeness. Advances in technology like the use of image guidance and surgical tools such as endoscopes and surgical robots have helped devise lesser morbid procedures and to allow access to the so-called inaccessible areas avoiding gross open surgery.

Reconstructive methods have significantly evolved ever since the time of Beckamjian and McGregor who pioneered the concept of deltopectoral flap[1] and forehead flap.[2] Soon after, with the introduction of Pectoralis major flap the concept changed to immediate and single stage reconstruction.[3] Following this, several myocutaneous flaps and their modifications were reported for head and neck reconstruction.[4],[5],[6],[7],[8],[9] Some of them got an acceptance, whereas some did not. Pectoralis major myocutaneous flap remained a big workhorse flap and made the life of head and neck surgeon comfortable. However, the reconstruction of bony defects remained a challenge. The introduction of microvascular free flaps revolutionized the field of reconstruction, allowing immediate reconstruction using like for like tissues in abundant quantity. Radial forearm flap was the first one which got to extensive clinical use. However, the most significant change that free tissue transfer brought in was in the way bony defects were reconstructed. The introduction of iliac crest[10] and fibula[11] free flaps offered more safe and reliable methods of reconstructing the anterior mandibular defects. The advent of free flaps also helped undertake more complex maxillary and skull base reconstruction in routine clinical practice.[12]

The current practice of reconstructive surgery has gone beyond microvascular free flaps. Use of digital technology for virtual surgical planning and making stereolithographic models has helped attain better bony reconstruction.[13],[14] Dental rehabilitation has been one of the areas where attention is given, and the advances in implant technology coupled with the digital planning have made it possible to provide precise dentition to the reconstructed jaws. Even the surgical robot has been used for reconstructive procedures allowing the use of free flaps after transoral resections. Use of navigation now allows precise placement of implants. All these have improved the quality of reconstruction that is offered to the patients at present.

Future of head and neck surgery is closely knit with that of the developments in reconstructive surgery. Currently, reconstructive surgery is hampered by the deficits created with donor defects. Regenerative medicine and tissue engineering may step in to provide “like” tissues without the necessity of harvesting it form the patient. The bioengineered maxilla has been created and used clinically.[15] However, achieving vascularization of the tissue-engineered construct is the unattained goal at present. This may be overcome with the use of 3D bioprinting,[16],[17] which has been reported to be successful for many tissues. Use of decellularized scaffolds and repopulating them with engineered cells from the patient may revolutionize the way reconstruction is dome in future.[18] Vascularized composite allotransplantation has come to stay for clinical use. It has proved that it is currently the best tool to give the best functional and esthetic results for complex facial deformities. Immunosuppression which is needed for them hinders its use for cancer defects.[19] However, this, if overcome in future with the development of immunotolerance-inducing methods, may make them the best options for reconstruction of complex defects.[20] Hence, the future is something worth looking for a head and neck oncologist. You may be able to prevent more cancers, cure whatever that occurs with lesser morbidity and rehabilitate the rest with the best possible function and form.

Disclosure

This material has never been published and is not currently under evaluation in any other peer reviewed publication.

Since this is an editorial article, no patients were involved. Ethical approval and informed consent waiver were obtained.



 
  References Top

1.
Bakamjian VY, Long M, Rigg B. Experience with the medially based deltopectoral flap in reconstructive surgery of the head and neck. Br J Plast Surg 1971;24:174-83.  Back to cited text no. 1
    
2.
McGregor JA, Reid WH. The use of the temporal flap in the primary repair of full-thickness defects of the cheek. Plast Reconstr Surg 1966;38:1-9.  Back to cited text no. 2
    
3.
Ariyan S. The pectoralis major myocutaneous flap. A versatile flap for reconstruction in the head and neck. Plast Reconstr Surg 1979;63:73-81.  Back to cited text no. 3
    
4.
Demergasso F, Piazza MV. Trapezius myocutaneous flap in reconstructive surgery for head and neck cancer: An original technique. Am J Surg 1979;138:533-6.  Back to cited text no. 4
    
5.
Futrell JW, Johns ME, Edgerton MT, Cantrell RW, Fitz-Hugh GS. Platysma myocutaneous flap for intra-oral reconstruction. Am J Surg 1978;136:504.  Back to cited text no. 5
    
6.
Quillen CG. Latissimus dorsi myocutaneous flaps in head and neck reconstruction. Plast Reconstr Surg 1979;63:664-70.  Back to cited text no. 6
    
7.
Ariyan S. One-stage reconstruction for defects of the mouth using a sternomastoid myocutaneous flap. Plast Reconstr Surg 1979;63:618-25.  Back to cited text no. 7
    
8.
Siemssen SO, Kirkby B, O'Connor TP. Immediate reconstruction of a resected segment of the lower jaw, using a compound flap of clavicle and sternomastoid muscle. Plast Reconstr Surg 1978;61:724-35.  Back to cited text no. 8
    
9.
Dufresne C, Cutting C, Valauri F, Klein M, Colen S, McCarthy JG. Reconstruction of mandibular and floor of mouth defects using the trapezius osteomyocutaneous flap. Plast Reconstr Surg 1987;79:687-96.  Back to cited text no. 9
    
10.
Taylor GI, Daniel RK. The free flap: Composite tissue transfer by vascular anastomosis. Aust N Z J Surg 1973;43:1-3.  Back to cited text no. 10
    
11.
Hidalgo DA. Fibula free flap: A new method of mandible reconstruction. Plast Reconstr Surg 1989;84:71-9.  Back to cited text no. 11
    
12.
Iyer S, Thankappan K. Maxillary reconstruction: Current concepts and controversies. Indian J Plast Surg 2014;47:8-19.  Back to cited text no. 12
[PUBMED]  [Full text]  
13.
Parthasarathy J. 3D modeling, custom implants and its future perspectives in craniofacial surgery. Ann Maxillofac Surg 2014;4:9-18.  Back to cited text no. 13
[PUBMED]  [Full text]  
14.
Rodby KA, Turin S, Jacobs RJ, Cruz JF, Hassid VJ, Kolokythas A, et al. Advances in oncologic head and neck reconstruction: Systematic review and future considerations of virtual surgical planning and computer aided design/computer aided modeling. J Plast Reconstr Aesthet Surg 2014;67:1171-85.  Back to cited text no. 14
    
15.
Mesimäki K, Lindroos B, Törnwall J, Mauno J, Lindqvist C, Kontio R, et al. Novel maxillary reconstruction with ectopic bone formation by GMP adipose stem cells. Int J Oral Maxillofac Surg 2009;38:201-9.  Back to cited text no. 15
    
16.
Kamali P, Dean D, Skoracki R, Koolen PG, Paul MA, Ibrahim AM, et al. The current role of three- dimensional printing in plastic surgery. Plast Reconstr Surg 2016;137:1045-55.  Back to cited text no. 16
    
17.
Suchyta M, Mardini S. Innovations and future directions in head and neck microsurgical reconstruction. Clin Plastic Surg 2017;44:325-44.  Back to cited text no. 17
    
18.
Duisit J, Maistriaux L, Taddeo A, Orlando G, Joris V, Coche E, et al. Bioengineering a human face graft, the matrix of identity. Ann Surg 2017;266:754-64.  Back to cited text no. 18
    
19.
Khalifian S, Brazio PS, Mohan R, Shaffer C, Brandacher G, Barth RN, et al. Facial transplantation: The first 9 years. Lancet 2014;384:2153-63.  Back to cited text no. 19
    
20.
Keener AB. Saving face: The search for alternatives to life-long immunosuppression for face transplants. Nat Med 2016;22:448-9.  Back to cited text no. 20
    




 

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