Cancer patients with large defects. Reconstructional options: A case study

Abstract

We report a case of a seventy-five years old male patient with a squamous cell carcinoma (SCC) originated from the right external ear four years ago. He was undergone surgical removal of the lesion with a combination of modified neck dissection and reconstruction with the use of pectoralis major flap. Furthermore, he had radiotherapy with 6000 rads of the right temporal region. Two months ago the patient showed an extended recurrence concerning the temporal muscle and bone, the lithoid bone, the masseter and the pterygoid muscles, the right part of the mandible, the parotid gland with the facial nerve, and the superior bulb of the internal jugular vein. He had a surgical removal of the lesion in extended healthy margins and functional and esthetic reconstruction of the defect with a combination of metal fixed prosthesis of the condyle and the right mandible and the use of myocutaneous trapezius flap. This is a case report of the reconstruction options we have nowadays to provide quality of life in cancer patients.

Modification of classic reconstructive techniques and evaluation of new esthetic methods in terms of the expectations of modern oto-rhino-laryngology and head-neck surgery

“…A precise evaluation of the extent of the defect, the patient's physiological data, and the area to be covered will guide the surgeon in choosing the best option (12,14,15). The extended lower trapezius musculocutaneous flap (ELTMF) and latissimus dorsi musculocutaneous flaps (LDMF) are the two available muscle compartments that can be transferred on a reliable vascular pedicle to the dorsal, suprascapular, and neck regions.…”

“…In comparison with the LDMF, we can say that the latissimus dorsi muscle offers a limited axis of rotation because of the axillary origin of its pedicle and the frequent need for a split thickness skin graft at the donor site because of the difficulty to achieve a tension-free closure of the wound during the management of extensive defects (12,14,15,52,53).…”

“…The ELTMF flap has several advantages: the donor site can usually be closed easily, resulting in a tension-free but rather long scar; the flap fills the defect created by the neck dissection and covers the vessels of the neck, preventing damage to the vessels; and the long, thin musculocutaneous pedicle allows for easy transfer of the island flap, which can even be tunneled into a defect if necessary (12,15,50,52,53) With our first solution, the LDMF, we found that the problem was the tunneling of the flap. However, the supplying vessels of the trapezius muscle and the muscle itself remained intact, and we were able to use this flap for the secondary reconstruction (12, 50).…”

Reconstruction of different tissue defects by means of various flaps in plastic surgery

“…As compared to the LDMF, it can be stated that the latissimus dorsi muscle offers a limited axis of rotation, its pedicle has an axillary origin and frequently there is a need for a split thickness skin graft at the donor site because it may be difficult to achieve a tension-free closure of the wound during the management of extensive defects (Urken et al, 1991;Papadas et al, 2005;Datta et al, 2009;Stillaert & Van Landuyt, 2009).…”

“…In reconstruction of soft tissue lesions in the neck, the primary goal is to appropriately cover the exposed vital organs with well-vascularized tissue harvested from a distant donor site (Ndayishimiye et al, 2009). Thorough defect analysis, evaluation of the patient's general condition and the anatomy of the defect site shall support the surgical decision on the applied method (Papadas et al, 2005;Datta et al, 2009). The extended lower trapezius myocutaneous flap (LTMF) and latissimus dorsi myocutaneous flap (LDMF) seem to provide good solution since these muscle compartments can be transferred on a reliable vascular pedicle to the dorsal, suprascapular and neck regions.…”