Innovative Vascularized Bone Alternatives in Head and Neck Reconstruction

Bony defects of the head and neck often require vascularized bone transplantation, particularly in cases complicated by radiation or infection. Often, the requirements cannot be fulfilled with the traditional options of fibula or iliac crest. This paper reported experience with innovative configurations of vascularized bone transfers in complex head and neck reconstruction.

Ten patients with bony head and neck defects as a result of cancer extirpation or infection were treated with alternative vascularized bone sources. Three patients with invasive scalp cancers underwent composite resection of the scalp and calvarium. One underwent wide excision of a recurrent melanoma, resulting in an occipital bony defect of 4 × 5 cm. A scapular plate osteocutaneous free flap was used for reconstruction. A second patient had recurrent invasive squamous cell cancer of the scalp complicated by cranial osteoradionecrosis and osteomyelitis. Resection resulted in a 25 × 30-cm scalp and calvarial defect. The wound was closed with a free latissimus dorsi osteomyocutaneous flap that included a vascularized rib strut. A third patient underwent a wide resection of a locally invasive tumor resulting in a 6 × 6-cm calvarial defect. The wound was closed with a deep circumflex iliac osteocutaneous flap containing 36 square cm of split iliac bone plate.

Additionally, four patients with segmental mandibular defects underwent reconstruction using full calvarial bone flaps (1 pedicled, 1 free), split calvarial bone flap (1 pedicled), and an 8-cm lateral iliac crest free flap (1). Finally, two patients with palatal defects underwent reconstruction with free split calvarial plate flap (1) and free split iliac plate flap (1).

Follow–up ranged between 1 and 13 years. There was one case of late flap failure secondary to overwhelming intra–oral herpes infection. One patient experienced limited distal flap necrosis and infection which was treated with debridement and dressing changes.

The authors presented successful immediate reconstruction of complex head and neck defects utilizing innovative sources of vascularized bone. Reconstruction of defects requiring bone plate reconstruction (calvarium and palate) were successfully accomplished using these alternative bone configurations.