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KEY FACTS
Terminology
Imaging
Diagnostic Checklist
TERMINOLOGY
Definitions
- Flap: Soft tissue ± muscle ± bone surgical site reconstruction
- Also known as microvascular reconstruction
- Soft tissue or autologous bone used to reconstruct postoperative resection defect in H&N
- Fasciocutaneous flap
- Flap constructed of deep muscle fascia with its overlying skin
- Used for smaller surgical reconstructions in H&N
- Allows harvesting of fasciocutaneous arterial perforators that pass along fascial septa between adjacent muscles
- Results in larger flap size survival at reconstruction site as needed
- Sensory cutaneous nerves also harvested when sensory reinnervation desired
- Donor sites primarily radial forearm, lateral arm, temporoparietal, rectus, latissimus dorsi, or anterolateral thigh
- Myocutaneous flap
- Flap constructed of muscle, soft tissue, and overlying skin
- Used when larger reconstruction site needs more volume (provided by muscle) to adequately fill surgical defect
- Donor sites include pectoralis major, rectus abdominis, or latissimus dorsi muscles
- Osteocutaneous flap
- Flap constructed with bone, soft tissue, and overlying skin ± muscle
- Also known as composite flap
- Used when reconstruction requires bone replacement
- Primarily employed in oral cavity squamous cell carcinoma (SCCa) reconstructions
- Portion of mandible or maxilla removed during tumor treatment surgery
- Muscle added to osteocutaneous flap if more volume needed for larger surgical defects
- Donor site usually fibula or scapula
- Flap constructed with bone, soft tissue, and overlying skin ± muscle
- Fasciocutaneous flap
- Flaps most commonly used to reconstruct tumor resection cavity
- Also used to repair posttraumatic defects in extracranial head and neck
- Osteocutaneous flap may be used to repair mandibular or maxillary osteonecrosis
- Flap: Soft tissue ± muscle ± bone surgical site reconstruction
IMAGING
General Features
Imaging Recommendations
CT Findings
MR Findings
DIFFERENTIAL DIAGNOSIS
PATHOLOGY
General Features
Staging, Grading, & Classification
CLINICAL ISSUES
Presentation
Demographics
Natural History & Prognosis
DIAGNOSTIC CHECKLIST
Consider
Image Interpretation Pearls
Reporting Tips
Selected References
- Patel SA et al: Principles and practice of reconstructive surgery for head and neck cancer. Surg Oncol Clin N Am. 24(3):473-489, 2015
- Glastonbury CM et al: Ossification of the vascular pedicle in microsurgical fibular free flap reconstruction of the head and neck. AJNR Am J Neuroradiol. 35(10):1965-9, 2014
- Wehage IC et al: Complex reconstructions in head and neck cancer surgery: decision making. Head Neck Oncol. 3:14, 2011
- Chan JW et al: Three- and four-dimensional computed tomographic angiography studies of the supraclavicular artery island flap. Plast Reconstr Surg. 125(2):525-31, 2010
- González-García R et al: Transport osteogenesis in the maxillofacial skeleton: outcomes of a versatile reconstruction method following tumor ablation. Arch Otolaryngol Head Neck Surg. 136(3):243-50, 2010
- Jacobson AS et al: Reconstruction of bilateral osteoradionecrosis of the mandible using a single fibular free flap. Laryngoscope. 120(2):273-5, 2010
- Kalavrezos N et al: Current trends and future perspectives in the surgical management of oral cancer. Oral Oncol. 46(6):429-32, 2010
- Kruse AL et al: Factors influencing survival of free-flap in reconstruction for cancer of the head and neck: a literature review. Microsurgery. 30(3):242-8, 2010
- Lee JT et al: Reconstruction of extensive composite oromandibular defects with simultaneous free anterolateral thigh fasciocutaneous and fibular osteocutaneous flaps. J Reconstr Microsurg. 26(3):145-51, 2010
- Nelson JA et al: The vastus lateralis muscle flap in head and neck reconstruction: an alternative flap for soft tissue defects. Ann Plast Surg. 64(1):28-30, 2010
- Pattani KM et al: What makes a good flap go bad? A critical analysis of the literature of intraoperative factors related to free flap failure. Laryngoscope. 120(4):717-23, 2010
- Sader C et al: Fat graft pedicle stabilization in head and neck microvascular reconstruction. Plast Reconstr Surg. 125(3):893-5, 2010
- Smith JE et al: Temporalis muscle flap for reconstruction of skull base defects. Head Neck. 32(2):199-203, 2010
- Abdel-Galil K et al: Postoperative monitoring of microsurgical free tissue transfers for head and neck reconstruction: a systematic review of current techniques--part I. Non-invasive techniques. Br J Oral Maxillofac Surg. 47(5):351-5, 2009
- Chien SH et al: Reconstruction of extensive head and neck defects with multiple simultaneous free flaps. Plast Reconstr Surg. 124(1):318, 2009
- Corten EM et al: Clinical outcome after pedicled segmental pectoralis major island flaps for head and neck reconstruction. Ann Plast Surg. 63(3):292-6, 2009
- Ethier JL et al: Pectoralis major myofascial flap in head and neck reconstruction: indications and outcomes. J Otolaryngol Head Neck Surg. 38(6):632-41, 2009
- Iseli TA et al: Functional outcomes following secondary free flap reconstruction of the head and neck. Laryngoscope. 119(5):856-60, 2009
- Nuara MJ et al: Prospective analysis of outcomes and complications of 300 consecutive microvascular reconstructions. Arch Facial Plast Surg. 11(4):235-9, 2009
- Sumer BD et al: Microvascular flap reconstruction of major pharyngeal resections with the intent of laryngeal preservation. Arch Otolaryngol Head Neck Surg. 135(8):801-6, 2009
- Ayad T et al: Reconstruction of floor of mouth defects by the facial artery musculo-mucosal flap following cancer ablation. Head Neck. 30(4):437-45, 2008
- Cordeiro PG: Frontiers in free flap reconstruction in the head and neck. J Surg Oncol. 97(8):669-73, 2008
- Dassonville O et al: Head and neck reconstruction with free flaps: a report on 213 cases. Eur Arch Otorhinolaryngol. 265(1):85-95, 2008
- Kramer M et al: Vascular mapping of head and neck: computed tomography angiography versus digital subtraction angiography. J Oral Maxillofac Surg. 66(2):302-7, 2008
- Murray DJ et al: Fasciocutaneous free flaps in pharyngolaryngo-oesophageal reconstruction: a critical review of the literature. J Plast Reconstr Aesthet Surg. 61(10):1148-56, 2008
- Oliver C et al: Interpretability of PET/CT imaging in head and neck cancer patients following composite mandibular resection and osteocutaneous free flap reconstruction. Head Neck. 30(2):187-93, 2008
- Thorwarth M et al: Free flap transfer in cranio-maxillofacial surgery: a review of the current data. Oral Maxillofac Surg. 12(3):113-24, 2008
- Bokhari WA et al: Tongue reconstruction: recent advances. Curr Opin Otolaryngol Head Neck Surg. 15(4):202-7, 2007
- Kelly AM et al: Preoperative MR angiography in free fibula flap transfer for head and neck cancer: clinical application and influence on surgical decision making. AJR Am J Roentgenol. 188(1):268-74, 2007
- Resto VA et al: Pectoralis major flap in composite lateral skull base defect reconstruction. Arch Otolaryngol Head Neck Surg. 133(5):490-4, 2007
- Richmon JD et al: Reconstruction of the hypopharynx: current trends. Curr Opin Otolaryngol Head Neck Surg. 15(4):208-12, 2007
- Smith RB et al: Scapula osteocutaneous free flap reconstruction of the head and neck: impact of flap choice on surgical and medical complications. Head Neck. 29(5):446-52, 2007
- Spiegel JH et al: Microvascular flap reconstruction by otolaryngologists: prevalence, postoperative care, and monitoring techniques. Laryngoscope. 117(3):485-90, 2007
- Podrecca S et al: Review of 346 patients with free-flap reconstruction following head and neck surgery for neoplasm. J Plast Reconstr Aesthet Surg. 59(2):122-9, 2006
- Morimoto Y et al: Instability of background fat intensity suppression using fat-saturated (FS) MR imaging techniques according to region and reconstruction procedure in patients with oral cancer. Oral Oncol. 40(3):332-40, 2004
- Hudgins PA: Flap reconstruction in the head and neck: expected appearance, complications, and recurrent disease. Semin Ultrasound CT MR. 23(6):492-500, 2002
- Tomura N et al: MR imaging of recurrent head and neck tumours following flap reconstructive surgery. Clin Radiol. 57(2):109-13, 2002
- Chong J et al: MR imaging of the muscular component of myocutaneous flaps in the head and neck. AJNR Am J Neuroradiol. 22(1):170-4, 2001
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References
Tables
Tables
KEY FACTS
Terminology
Imaging
Diagnostic Checklist
TERMINOLOGY
Definitions
- Flap: Soft tissue ± muscle ± bone surgical site reconstruction
- Also known as microvascular reconstruction
- Soft tissue or autologous bone used to reconstruct postoperative resection defect in H&N
- Fasciocutaneous flap
- Flap constructed of deep muscle fascia with its overlying skin
- Used for smaller surgical reconstructions in H&N
- Allows harvesting of fasciocutaneous arterial perforators that pass along fascial septa between adjacent muscles
- Results in larger flap size survival at reconstruction site as needed
- Sensory cutaneous nerves also harvested when sensory reinnervation desired
- Donor sites primarily radial forearm, lateral arm, temporoparietal, rectus, latissimus dorsi, or anterolateral thigh
- Myocutaneous flap
- Flap constructed of muscle, soft tissue, and overlying skin
- Used when larger reconstruction site needs more volume (provided by muscle) to adequately fill surgical defect
- Donor sites include pectoralis major, rectus abdominis, or latissimus dorsi muscles
- Osteocutaneous flap
- Flap constructed with bone, soft tissue, and overlying skin ± muscle
- Also known as composite flap
- Used when reconstruction requires bone replacement
- Primarily employed in oral cavity squamous cell carcinoma (SCCa) reconstructions
- Portion of mandible or maxilla removed during tumor treatment surgery
- Muscle added to osteocutaneous flap if more volume needed for larger surgical defects
- Donor site usually fibula or scapula
- Flap constructed with bone, soft tissue, and overlying skin ± muscle
- Fasciocutaneous flap
- Flaps most commonly used to reconstruct tumor resection cavity
- Also used to repair posttraumatic defects in extracranial head and neck
- Osteocutaneous flap may be used to repair mandibular or maxillary osteonecrosis
- Flap: Soft tissue ± muscle ± bone surgical site reconstruction
IMAGING
General Features
Imaging Recommendations
CT Findings
MR Findings
DIFFERENTIAL DIAGNOSIS
PATHOLOGY
General Features
Staging, Grading, & Classification
CLINICAL ISSUES
Presentation
Demographics
Natural History & Prognosis
DIAGNOSTIC CHECKLIST
Consider
Image Interpretation Pearls
Reporting Tips
Selected References
- Patel SA et al: Principles and practice of reconstructive surgery for head and neck cancer. Surg Oncol Clin N Am. 24(3):473-489, 2015
- Glastonbury CM et al: Ossification of the vascular pedicle in microsurgical fibular free flap reconstruction of the head and neck. AJNR Am J Neuroradiol. 35(10):1965-9, 2014
- Wehage IC et al: Complex reconstructions in head and neck cancer surgery: decision making. Head Neck Oncol. 3:14, 2011
- Chan JW et al: Three- and four-dimensional computed tomographic angiography studies of the supraclavicular artery island flap. Plast Reconstr Surg. 125(2):525-31, 2010
- González-García R et al: Transport osteogenesis in the maxillofacial skeleton: outcomes of a versatile reconstruction method following tumor ablation. Arch Otolaryngol Head Neck Surg. 136(3):243-50, 2010
- Jacobson AS et al: Reconstruction of bilateral osteoradionecrosis of the mandible using a single fibular free flap. Laryngoscope. 120(2):273-5, 2010
- Kalavrezos N et al: Current trends and future perspectives in the surgical management of oral cancer. Oral Oncol. 46(6):429-32, 2010
- Kruse AL et al: Factors influencing survival of free-flap in reconstruction for cancer of the head and neck: a literature review. Microsurgery. 30(3):242-8, 2010
- Lee JT et al: Reconstruction of extensive composite oromandibular defects with simultaneous free anterolateral thigh fasciocutaneous and fibular osteocutaneous flaps. J Reconstr Microsurg. 26(3):145-51, 2010
- Nelson JA et al: The vastus lateralis muscle flap in head and neck reconstruction: an alternative flap for soft tissue defects. Ann Plast Surg. 64(1):28-30, 2010
- Pattani KM et al: What makes a good flap go bad? A critical analysis of the literature of intraoperative factors related to free flap failure. Laryngoscope. 120(4):717-23, 2010
- Sader C et al: Fat graft pedicle stabilization in head and neck microvascular reconstruction. Plast Reconstr Surg. 125(3):893-5, 2010
- Smith JE et al: Temporalis muscle flap for reconstruction of skull base defects. Head Neck. 32(2):199-203, 2010
- Abdel-Galil K et al: Postoperative monitoring of microsurgical free tissue transfers for head and neck reconstruction: a systematic review of current techniques--part I. Non-invasive techniques. Br J Oral Maxillofac Surg. 47(5):351-5, 2009
- Chien SH et al: Reconstruction of extensive head and neck defects with multiple simultaneous free flaps. Plast Reconstr Surg. 124(1):318, 2009
- Corten EM et al: Clinical outcome after pedicled segmental pectoralis major island flaps for head and neck reconstruction. Ann Plast Surg. 63(3):292-6, 2009
- Ethier JL et al: Pectoralis major myofascial flap in head and neck reconstruction: indications and outcomes. J Otolaryngol Head Neck Surg. 38(6):632-41, 2009
- Iseli TA et al: Functional outcomes following secondary free flap reconstruction of the head and neck. Laryngoscope. 119(5):856-60, 2009
- Nuara MJ et al: Prospective analysis of outcomes and complications of 300 consecutive microvascular reconstructions. Arch Facial Plast Surg. 11(4):235-9, 2009
- Sumer BD et al: Microvascular flap reconstruction of major pharyngeal resections with the intent of laryngeal preservation. Arch Otolaryngol Head Neck Surg. 135(8):801-6, 2009
- Ayad T et al: Reconstruction of floor of mouth defects by the facial artery musculo-mucosal flap following cancer ablation. Head Neck. 30(4):437-45, 2008
- Cordeiro PG: Frontiers in free flap reconstruction in the head and neck. J Surg Oncol. 97(8):669-73, 2008
- Dassonville O et al: Head and neck reconstruction with free flaps: a report on 213 cases. Eur Arch Otorhinolaryngol. 265(1):85-95, 2008
- Kramer M et al: Vascular mapping of head and neck: computed tomography angiography versus digital subtraction angiography. J Oral Maxillofac Surg. 66(2):302-7, 2008
- Murray DJ et al: Fasciocutaneous free flaps in pharyngolaryngo-oesophageal reconstruction: a critical review of the literature. J Plast Reconstr Aesthet Surg. 61(10):1148-56, 2008
- Oliver C et al: Interpretability of PET/CT imaging in head and neck cancer patients following composite mandibular resection and osteocutaneous free flap reconstruction. Head Neck. 30(2):187-93, 2008
- Thorwarth M et al: Free flap transfer in cranio-maxillofacial surgery: a review of the current data. Oral Maxillofac Surg. 12(3):113-24, 2008
- Bokhari WA et al: Tongue reconstruction: recent advances. Curr Opin Otolaryngol Head Neck Surg. 15(4):202-7, 2007
- Kelly AM et al: Preoperative MR angiography in free fibula flap transfer for head and neck cancer: clinical application and influence on surgical decision making. AJR Am J Roentgenol. 188(1):268-74, 2007
- Resto VA et al: Pectoralis major flap in composite lateral skull base defect reconstruction. Arch Otolaryngol Head Neck Surg. 133(5):490-4, 2007
- Richmon JD et al: Reconstruction of the hypopharynx: current trends. Curr Opin Otolaryngol Head Neck Surg. 15(4):208-12, 2007
- Smith RB et al: Scapula osteocutaneous free flap reconstruction of the head and neck: impact of flap choice on surgical and medical complications. Head Neck. 29(5):446-52, 2007
- Spiegel JH et al: Microvascular flap reconstruction by otolaryngologists: prevalence, postoperative care, and monitoring techniques. Laryngoscope. 117(3):485-90, 2007
- Podrecca S et al: Review of 346 patients with free-flap reconstruction following head and neck surgery for neoplasm. J Plast Reconstr Aesthet Surg. 59(2):122-9, 2006
- Morimoto Y et al: Instability of background fat intensity suppression using fat-saturated (FS) MR imaging techniques according to region and reconstruction procedure in patients with oral cancer. Oral Oncol. 40(3):332-40, 2004
- Hudgins PA: Flap reconstruction in the head and neck: expected appearance, complications, and recurrent disease. Semin Ultrasound CT MR. 23(6):492-500, 2002
- Tomura N et al: MR imaging of recurrent head and neck tumours following flap reconstructive surgery. Clin Radiol. 57(2):109-13, 2002
- Chong J et al: MR imaging of the muscular component of myocutaneous flaps in the head and neck. AJNR Am J Neuroradiol. 22(1):170-4, 2001
