Reconstructive Surgery

Introduction:

In India, oral malignancies account for 35% of total malignancies. Surgical excision of tumor and neck dissection forms the mainstay of treatment in addition to adjuvant chemotherapy and radiotherapy. The resulting anatomical defect, functional loss, cosmetic disfigurement and the accompanying psychosocial effects can be devastating to the patient. Reconstructive surgery for head and neck defects remains an evolving challenge and plays a crucial role in improving the quality of life by restoring anatomical defect, achieving functional rehabilitation and aesthetic outcome. For many years reconstructive surgeons have used regional flaps, such as the pectoralis major myocutaneous, trapezius, latissimus dorsi or deltopectoral flaps

However free tissue transfer requires specialized expertise that may not be readily available in all centres, requires a longer operative time, extensive postoperative monitoring and most patients are not good candidates for free tissue transfer because of their medical comorbodities or lack of recipient vessels for anastomosis. In addition, traditional regional flaps do not always meet needs of the specific defects. Ultimate goal of reconstructive surgical procedures after tumor resection in head and neck in not limited to cover the defect, but also to recreate anatomical functional units in three dimensions with similar skin color and texture match as the original skin at the recipient site. Over the past three decades our knowledge of the skin vascular anatomy and physiology has led to several advancements in flap harvesting techniques. As a result, forgotten flaps like the supraclvicular flap has been rediscovered by several groups after an extended period of absence from the literature. To our knowledge this flap has rarely been described in literature for head and neck reconstruction after tumor resection. The supraclavicular flap is a versatile flap adding to the armamentarium of head and neck

1872 Estlander Repair of lateral defects of the lower lip using lateral upper lip

1889 Manchot Definition of vascular patterns of cutaneous circulation by dissection

1898 Halsted Waltzing flaps

1898 Abbe Bilateral cleft lip reconstruction with cross lip flaps

1905 Tansini Latissimus dorsi musculocutanous flap for breast reconstruction

1912 Blair Osseocutaneous flap

1916 Filatov Tubed pedicle neck flap for lower eyelid reconstruction

1917 Gilles Tubed pedicle neck flaps

1917 Aymand Tubed pedicle chest flap for nasal reconstruction

1917 Ganzer Tubed pedicle flaps from the cheek, shoulder for nasal reconstruction

1919 Davis Published observations on pedicle flap