Modalities and State of Art in Oral Cancer Reconstruction

Abstract

The treatment of the oral cancer is complex in terms of resection and reconstruction. Adequate multidisciplinary approach is needed to plan the oncological resection and functional reconstruction to obtain optimal results and adequate rehabilitation of the patient. Many factors should be considered in order to reconstruct the surgical defects, including patient factors, the expertise of the team, and other tumor and defect factors. Early cancer and its subsequent defects can be reconstructed merely with a primary closure or a skin graft, but as soon as the cancer stage worsens, the devastation of primary tumor is bigger needing a more complex surgery and skilled reconstructive techniques to implant a new safe tissue, starting from a local flap, a pediculate flap, and up to a free composite flap. Nowadays there is a trend to perform microvascular free flaps in most of the reconstructions, but if a rational approach is planned, even in the most advanced cases, it can be solved with locoregional flaps, limiting the need of a microvascular surgery and its subsequent overcost in care and special skills in reconstruction. This chapter pretends to give a rational approach to get that goal.

Reconstruction of glossectomy defects post oncologic resection

“…The choice of the flap to reconstruct a tongue defect mainly depends on four parameters: the tongue defect size, existence of neck donor vessels, floor-of-mouth affection, or existence of mandible or oropharyngeal defects (13) .…”

“…The reconstructive ladders begin from healing by secondary intention, to primary closure, skin grafting, loco-regional flaps and lastly free tissue transmission (figure 1). Generally, immediate reconstruction at the time of tumor excision induces optimum functional outcomes because one can predict marked volume loss over time postradiation therapy (13) .…”