title: Prophylactic chimera anterolateral thigh/vastus lateralis flap: preventing complications in high-risk head and neck reconstruction.
abstract: OBJECTIVE
  In high-risk head and neck cases treated with tumor resection and associated radical neck dissection, orocutaneous fistulas and wound breakdowns in the neck are relatively frequent and can have serious consequences, such as carotid blowout syndrome (CBS), the need for salvage reoperations, and prolonged recovery time. The authors present the application of a prophylactic chimeric anterolateral thigh (ALT) and vastus lateralis (VL) flap to prevent complications.
  
  
  METHODS
  A retrospective review was performed of a historical group (96 patients) of patients with head and neck cancer treated with tumor resection, radical neck dissection, and microsurgical reconstruction of the tumor site only and a prospective cohort (21 patients) in which a chimeric ALT-VL flap was used to simultaneously reconstruct the tumor site and sternocleidomastoid muscle to fill dead space and protect the carotid artery.
  
  
  RESULTS
  The rate of complications was higher in the historical group: CBS occurred in 4.1% and orocutaneous fistulas in 11.5% of patients; 5.2% of patients required major salvage surgery for a wound complication. In the cohort group, no CBS or orocutaneous fistula occurred and no major salvage surgical procedure was needed.
  
  
  CONCLUSIONS
  Prophylactic ALT-VL flaps in high-risk head and neck cancers provide adequate and long-lasting soft tissue coverage for the carotid artery, with minimal additional morbidity, and could be beneficial in preventing serious and life-threatening wound complications and the need for reoperation.
authors.affiliation: Full Professor, Plastic and Reconstructive Surgery, Department of Surgical, Oncological, and Oral Sciences, University of Palermo, Palermo, Italy. Electronic address: adriana.cordova.unipa@gmail.com.
authors.forename: Adriana
authors.initials: A
authors.lastname: Cordova
authors.affiliation: Doctor, Plastic and Reconstructive Surgery, Department of Surgical, Oncological, and Oral Sciences, University of Palermo, Palermo, Italy.
authors.forename: Salvatore
authors.initials: S
authors.lastname: D'Arpa
authors.affiliation: Doctor, Plastic and Reconstructive Surgery, Department of Surgical, Oncological, and Oral Sciences, University of Palermo, Palermo, Italy.
authors.forename: Sara
authors.initials: S
authors.lastname: Di Lorenzo
authors.affiliation: Doctor, Plastic and Reconstructive Surgery, Department of Surgical, Oncological, and Oral Sciences, University of Palermo, Palermo, Italy.
authors.forename: Francesca
authors.initials: F
authors.lastname: Toia
authors.affiliation: Full Professor, Section of Oral Medicine "V. Margiotta", Department of Surgical, Oncological, and Oral Sciences, University of Palermo, Palermo, Italy.
authors.forename: Giuseppina
authors.initials: G
authors.lastname: Campisi
authors.affiliation: Full Professor, Plastic and Reconstructive Surgery, Department of Surgical, Oncological, and Oral Sciences, University of Palermo, Palermo, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Moschella
mesh_terms: D000328:Adult; D000368:Aged; D016063:Blood Loss, Surgical / Q000517:prevention & control; D020212:Carotid Artery Injuries / Q000517:prevention & control; D059186:Chemoradiotherapy, Adjuvant; D015331:Cohort Studies; D017577:Cutaneous Fistula / Q000209:etiology; D005260:Female; D005500:Follow-Up Studies; D006258:Head and Neck Neoplasms / Q000601:surgery*; D006801:Humans; D007431:Intraoperative Complications / Q000517:prevention & control; D008297:Male; D008866:Microsurgery / Q000379:methods; D008875:Middle Aged; D018482:Muscle, Skeletal / Q000637:transplantation*; D037981:Neck Dissection / Q000534:rehabilitation; D009334:Neck Muscles / Q000601:surgery; D020360:Neoadjuvant Therapy; D016155:Oral Fistula / Q000209:etiology; D011183:Postoperative Complications / Q000517:prevention & control*; D011446:Prospective Studies; D019651:Plastic Surgery Procedures / Q000379:methods*; D012086:Reoperation; D012189:Retrospective Studies; D016879:Salvage Therapy; D013524:Surgical Flaps / Q000637:transplantation*; D013529:Surgical Wound Dehiscence / Q000209:etiology