Frontiers in free flap reconstruction in the head and neck

Abstract

This chapter describes the state of the art in head and neck free flap reconstruction and will stress some of its major deficits. It will also discuss some of the most promising frontiers in reconstruction, including tissue engineering and composite allotransplantation. The true frontiers of reconstruction need to be refined at the cellular level where tissue engineered from the individual cells and manipulation of the patient's immune system will potentially allow allotransplantation without affecting rates of cancer cure.

Long-Term Survival of Composite Hemiface/Mandible/Tongue Allografts Correlates With Multilineage Chimerism Development in the Lymphoid and Myeloid Compartments of Recipients

“…For the reconstruction of these severe multitissue defects, traditional reconstructive procedures including skin grafts, local flaps, pedicled flaps, distant flaps, preexpanded flaps, tissue prefabrication, and free tissue transfers were used during past decade (1)(2)(3)(4). Limitations of classical microsurgical reconstruction of orofacial deficits include (1) difficulty to match skin quality and color; (2) lack of tissues resembling oral lining of cheek and oral mucosa; and (3) lack of spare, intraoral mobile structures such as tongue and pharyngeal musculature (5). For these reasons, application of composite tissue allografts (CTAs) for complex orofacial reconstruction would maximize the aesthetic and functional outcomes (5)(6)(7)(8)(9)(10).…”

“…Limitations of classical microsurgical reconstruction of orofacial deficits include (1) difficulty to match skin quality and color; (2) lack of tissues resembling oral lining of cheek and oral mucosa; and (3) lack of spare, intraoral mobile structures such as tongue and pharyngeal musculature (5). For these reasons, application of composite tissue allografts (CTAs) for complex orofacial reconstruction would maximize the aesthetic and functional outcomes (5)(6)(7)(8)(9)(10). CTA may be considered for these multitissue reconstructions because of development of modern immunosuppressive agents, applied in clinical cases of hand and face transplants (11,12).…”

Arguing the Ethics of Facial Transplantation

“…Clearly, not every facial defect warrants a face transplant, but for a particular constellation of injuries that violate multiple facial subunits-including the eyelids, nose, palate, and/or lip-mouth complex-the functional ramifications on eye protection, speech, breathing, and mastication, as well as the resultant aesthetic abnormality, may be too substantial for autologous tissue reconstruction to be effective. [1][2][3] Autologous tissue transfer requires numerous surgical interventions, which produce a mosaic of different tissue units that are restricted at their perimeters by scar; the result can be a masklike appearance, with limited expressivity and functionality. Insofar as the reconstructive goals are both to improve appearance to facilitate social interaction and to reestablish some amount of basic facial function, facial transplantation offers a solution when other interventions fall short.…”

Assessment of silk fibroin for the repair of buccal mucosa in a rat model

“…Over the past three decades the options for reconstructive surgery of mandible defects have increased to enable the re-establishment of mandible continuity and optimal soft-tissue reconstruction 6 . Numerous advances in microsurgical techniques, plating technology and instrumentation, and an understanding of donor site angiosomes have made consistent and reliable mandibular reconstruction possible 13 .…”