Background. Between June and August 2016, three patients presented with complex squamous cell carcinoma of the head & neck region which required large surface reconstruction between 500-785 cm2. All patients were males aged 50-80 years and all were of medium to slim build. For each case the commonly employed flaps would have been insufficient to provide complete coverage. A single flap option with a low-morbidity donor site was preferred.
Methods. None of the three patients had prior abdominal scarring. The abdominal tissue in each patient was thought to be the largest possible single flap option available. No preoperative angiogram was performed. There were two free TRAM flap reconstructions (subtotal scalp / bilateral facial soft tissue and anterior neck / chest wall), and a free SIEA flap laryngectomy reconstruction. Flap raising time ranged from 90-140 minutes, and was performed concurrent to the resection surgery. All donor sites were closed primarily in abdominoplasty fashion.
Findings. All flaps survived. Complications included minor wound dehiscence in the two TRAM flaps, and an infected seroma in the SIEA flap. The authors believe that at 785cm2, the subtotal scalp / bilateral facial soft tissue reconstruction represents the largest single free flap reconstruction of a head and neck defect.(1)
Conclusions. Abdominal free flaps offer great utility in head and neck reconstruction in thin patients. A large amount tissue is available based on a single pedicle or supercharged with an additional pedicle. Intraoperative positional changes are not required and the flaps can be raised simultaneous to the ablative resection, reducing operative time and risk.(2) Abdominal free flaps are associated with low donor-site morbidity with a cosmetically acceptable scar.