title: Free flap reconstruction after robot-assisted neck dissection via a modified face-lift or retroauricular approach.
abstract: BACKGROUND
  We performed robot-assisted neck dissection (RAND) via a modified face-lift (MFLA) or retroauricular approach for neck management and carried out free flap reconstruction via these approaches in patients with head and neck cancer. We assessed the feasibility of free flap reconstruction in patients who had undergone transoral resection of a primary lesion and RAND via these approaches.
  
  
  METHODS
  In this prospective study, seven patients with head and neck squamous cell carcinoma were enrolled between August 2011 and May 2012. Approval was obtained from the institutional review board of Yonsei University. A radial forearm free flap was used for reconstruction because of its thin structure and pliability. Microvascular anastomosis was performed via an MFLA or retroauricular approach using a microscope and microvascular instrument set.
  
  
  RESULTS
  Pathology reports showed a negative margin in all patients. On the basis of pathologic information for the primary lesion and neck specimens, 5 patients underwent surgery alone and two received adjuvant radiotherapy. At the last outpatient department visit, all patients were alive without locoregional recurrence. All patients were extremely satisfied with the invisible postoperative scar. On average, patients tolerated an oral diet after 1-2 weeks. The status of the free flap was viable and functioning in all patients.
  
  
  CONCLUSIONS
  Although long-term follow-up of oncologic safety is required to establish these approaches as valid treatment methods, our study has demonstrated the feasibility of free flap reconstruction and RAND via an MFLA or retroauricular approach.
authors.affiliation: Department of Otorhinolaryngology, Yonsei University College of Medicine, Seoul, South Korea.
authors.forename: Young Min
authors.initials: YM
authors.lastname: Park
authors.forename: Won Jai
authors.initials: WJ
authors.lastname: Lee
authors.forename: In Sik
authors.initials: IS
authors.lastname: Yun
authors.forename: Dong Won
authors.initials: DW
authors.lastname: Lee
authors.forename: Dae Hyun
authors.initials: DH
authors.lastname: Lew
authors.forename: Jeon Mi
authors.initials: JM
authors.lastname: Lee
authors.forename: Jong-Gyun
authors.initials: JG
authors.lastname: Ha
authors.forename: Won Shik
authors.initials: WS
authors.lastname: Kim
authors.forename: Yoon Woo
authors.initials: YW
authors.lastname: Koh
authors.forename: Eun Chang
authors.initials: EC
authors.lastname: Choi
mesh_terms: D000328:Adult; D000368:Aged; D002294:Carcinoma, Squamous Cell / Q000473:pathology / Q000601:surgery*; D005240:Feasibility Studies; D005260:Female; D005500:Follow-Up Studies; D058752:Free Tissue Flaps; D006258:Head and Neck Neoplasms / Q000473:pathology / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D037981:Neck Dissection; D009367:Neoplasm Staging; D011183:Postoperative Complications; D011379:Prognosis; D011446:Prospective Studies; D019651:Plastic Surgery Procedures; D015361:Rhytidoplasty; D012371:Robotics