Surgical Strategies and Imaging for Regional Flaps in the Head and Neck
Surgical reconstruction of the head and neck is predominantly required after tumour resections but also in cases of trauma, infection, and congenital abnormalities.41 In today’s ageing population, a large proportion of head and neck reconstruction is performed to correct complex defects created by surgical resection of advanced head and neck cancers. Free-ap reconstruction of such defects may not be ideal in such patients given their advanced age and co-morbidities. Local and regional aps provide reconstructive options with comparatively less morbidity and operative risk.5 Furthermore, local and regional aps provide like-for-like tissue, which is well matched in terms of texture and colour to the recipient site.33 This is particularly advantageous in the head and neck where cosmesis is especially important given the visibility of this area and the associated psychosocial implications.
Head and neck reconstruction dates as far back as the sixth century BC during which the ancient Indians used local aps for nasal reconstruction.47 Until the mid-twentieth century, the lack of understanding of the vascular supply of aps resulted in head and neck reconstruction methods being restricted to direct closure and random aps (local aps and delayed aps performed over multiple surgeries), all of which had limited use in the reconstruction of larger defects.50 This was