Reconstructieve mogelijkheden na tumorchirurgie in het hoofd-halsgebied

Surgery and radiotherapy are the most important primary modalities for treatment of head and neck cancer. After excision of a tumour, a considerable defect may remain. Reconstructive surgery may serve several purposes: closure of the defect and restitution of functions such as respiration, swallowing, speech and chewing. Also, an esthetically satisfying appearance is aimed at. The planning of reconstructive surgery starts as soon as a patient presents with a new cancer. The most appropriate procedure is selected by a team of specialists, consisting of head and neck surgeon, a plastic and reconstructive surgeon and a maxillofacial surgeon. For defects of the mouth and oropharynx, a microsurgical free flap is the most versatile and safe choice of reconstruction nowadays. Suitable donor areas are the forearm, iliac crest and abdominal wall and the fibula. The graft, which may consist of skin, fascia, muscle, bone or combinations thereof, is revascularised in the defect area after microsurgical anastomosis of its vascular pedicle. Success percentages are greater than 95% and postoperative morbidity is reduced in contrast to conventional methods