title: Stepladder reconstructive options in post-ablative complex surgical defects in the head and neck.
abstract: BACKGROUND
  Reconstruction of head and neck defects can pose many challenges to the reconstructive head and neck surgeon. Achieving the best cosmetic and functional results without compromising the safety of oncologic surgery are the primary reconstructive goals. Speech and articulation are particularly important in oral reconstructive procedures. In addition, preservation of the integrity and function of the donor sites should always be considered in all reconstructive procedures.
  
  
  OBJECTIVE
  The aim of the study is to evaluate different reconstructive options in complex defects of the head and neck region after resection of malignant tumours. The feasibility of the reconstructive ladder starting from simple techniques such as local flaps and skin grafts up to free flaps will be assessed.
  
  
  METHODS
  In this study we evaluated different reconstructive procedures used in 50 patients with complex head and neck defects undertaken at the department of surgery at the National Cancer Institute between July 2003 and December 2007.
  
  
  RESULTS
  The average age of patients was 52 years and the range was 26-67 years. Most of the tumours were either squamous cell carcinoma (74 %) or Basal cell carcinoma (20 %). Tumour sites included the nose (6 %), lip (10 %), cheek (12 %) scalp (6 %) as well as mucosal defects of the oral cavity (40 %) and the hypopharynx (20 %). We used local flaps and skin grafts in reconstruction in 36 % of cases and pedicled flaps in 32% while free flaps were used in 32 % of cases. Complications occurred in 32 % of patients of which total flaps loss constituted 6 % and partial flap loss 4 %. Minor complications such as oro-cutaneous fistulae, wound infection, seroma and haematoma were noticed in 22 % and all of them were treated conservatively. The final functional and aesthetic results were satisfactory in 60% of cases while poor results were encountered in patients who suffered some degree of flap loss.
  
  
  BACKGROUND
  Head and neck reconstruction - Pedicled flaps - Free flaps.
authors.affiliation: The Departments of Surgical Oncology, National Cancer Institute, Cairo University.
authors.forename: Hamdy H
authors.initials: HH
authors.lastname: El Marakby
authors.forename: Sherif F
authors.initials: SF
authors.lastname: Naguib
authors.forename: Abd El-Hamid F
authors.initials: Ael-H
authors.lastname: El-Sawy
authors.forename: Ayman A
authors.initials: AA
authors.lastname: Amin