Principles of Cancer Reconstructive Surgery (eBook)

Preface 6
Table of Contents 7
Contributors 9
1 Plastic Surgery A Component in the Comprehensive Care of Cancer Patients 12
General Role of Plastic Surgery 12
Breast Cancer 13
Expander/Implant Reconstruction 14
LD Flap with Implant 16
Abdominal Flaps 17
Reconstruction for Lumpectomy Defects 19
Nipple/Areola Reconstruction 20
Head and Neck Cancers 20
Intraoral Defects 21
Mandibular Defects 21
Defects of Pharynx and Cervical Esophagus 22
Defects of Facial Skin and Soft Tissue 23
Sarcoma 24
Conclusion 24
References 24
2 The Principles of Cancer Reconstruction 27
References 39
3 Breast Reconstruction Timing and Coordination with Adjuvant Therapy 41
The Impact of Axillary Sentinel Node Biopsy on the Timing of Breast Reconstruction 41
The Influence of the Need for PRMT on the Timing of Breast Reconstruction 44
The Difficulties with Radiation Delivery after Immediate Breast Reconstruction 44
The Adverse Affects of PMRT on the Aesthetic Outcome of an Immediate Breast Reconstruction 45
The Effect of the Clinical Stage of Breast Cancer on the Timing of Breast Reconstruction 46
The Evolving Options for the Sequencing of Breast Reconstruction and Adjuvant Therapy 47
Immediate Breast Reconstruction 47
Delayed Breast Reconstruction 47
Delayed-Immediate Breast Reconstruction 50
Coordinating Adjuvant or Neoadjuvant Chemotherapy Along with Breast Reconstruction 54
Important Considerations for the Multi-Disciplinary Breast Cancer Team 56
References 57
4 Breast Reconstruction Autogenous Tissue 60
Introduction 60
History of Autogenous Reconstruction 61
The Latissimus Dorsi Myocutaneous Flap 62
The Pedicled TRAM Flap 63
The Free TRAM Flap 64
The DIEP Flap 66
The SIE Flap 66
The Superior and Inferior Free Gluteal Flap 67
The SGAP and Inferior Gluteal Artery Perforator (IGAP) Flap 68
Recipient Vessel Sites for Free Flap Breast Reconstruction 69
Immediate Versus Delayed Autogenous Breast Reconstruction 70
Conclusion 71
References 71
5 Breast Reconstruction Implant and Nipple Reconstruction 73
Introduction 73
Reconstructive Options 73
Implant Reconstruction 74
Combined Autogenous TissuelImplant Reconstruction 76
Complications 77
Advantages/Disadvantages 78
Timing of Reconstruction 79
Skin-Sparing Mastectomy 79
Adjuvant Therapy and Implant Reconstruction 80
Nipple-Areola Reconstruction 80
Timing 81
Relevant Anatomy 81
Nipple Reconstruction 81
Nipple sharing 81
Nipple tattooing 82
Grafting and soft-tissue fillers 82
Local flaps 82
The "skate flap": a technical approach 82
The C-V flap: a technical approach 87
Complications 87
Areola Reconstruction 89
Primary intradermal tattooing 89
Skin-grafting 90
Conclusion 90
References 90
6 Skin Cancer and Reconstruction 92
Introduction 92
Epidemiology 92
Pathophysiology 93
Classification 94
Treatment: Surgical 95
Margins 95
Reconstruction 96
Timing 96
Techniques 96
Primary closure 97
Healing by secondary intention 98
Skin grafts 98
Flaps 99
Conclusion 102
Reference 104
7 Lip, Cheek, and Scalp Reconstruction 107
Lip Reconstruction 107
History 107
Goals of Reconstruction 107
Lip Neoplasms 107
Anatomy 107
Reconstruction 108
Vermilion defects 108
Defects involving less than one-third 109
Defects greater than one-third 109
Cheek Reconstruction 113
Introduction 113
Goals of Reconstruction 113
Anatomy 114
Zone 1: suborbital 114
Zone 2: preauricular 114
Zone 3: buccomandibular 114
Innervation and blood supply 114
Reconstruction 115
Skin grafts 115
Local and regional flaps 115
Distant flaps 118
Scalp Reconstruction 118
History 118
Goals of Reconstuction 119
Anatomy 119
Layers 119
Blood supply 120
Innervation 120
Scalp Neoplasms 120
Evaluation of the Defect 120
Reconstruction 120
Primary closure and skin grafting 120
Local scalp flaps 121
Free flaps 122
Calvarial defects 123
References 124
8 Reconstruction of Mandible, Maxilla, and Skull Base 128
Mandible 129
Introduction 129
Classification of Mandibular Defects 129
Principles of Reconstruction 130
Choice of Reconstruction 134
Fibular osseocutaneous free flap 135
Iliac crest osseocutaneous flap 135
Scapular osseocutaneous flap 136
Radial forearm osseocutaneous flap 136
Special Considerations 137
Reconstruction of the condyle 137
Dental rehabilitation 138
Summary 138
Maxilla 139
Introduction 139
Classification 139
Reconstructive Options 140
Special Considerations 144
Skull Base 144
Introduction 144
Principles of Reconstruction 144
Classification 145
Reconstructive Options 146
Special Considerations 147
Conclusion 147
References 147
9 Pharynx, Cervical Esophagus, and Oral Cavity Reconstruction 152
Reconstructive Requirements 153
Oral Cavity 153
Pharynx 154
Cervical Esophagus 155
Surgical Planning 156
Question 1: What is the defect? 157
Question 2: What must I fix today? 157
Question 3: What tools are available? 157
Reconstructive Options 158
Primary and Secondary Closure 158
Skin Grafting 158
Local Flaps 159
Regional Flaps 162
Free Tissue Transfer 164
Assessing Outcomes 169
Conclusion 169
References 169
10 Concepts in Nasal Reconstruction 172
Introduction: The Challenge of Nasal Reconstruction 172
History of Nasal Reconstruction 172
Nasal Anatomy 174
Surgical Strategy in Nasal Reconstruction 175
Goals and Timing 175
Assessment of the Defect 177
Formulating the Surgical Plan 177
Replacement of Nasal Cover 178
Secondary Intention 178
Skin Grafts 178
Composite Auricular Grafts 179
Local Nasal Flaps 180
Regional Flaps 182
Cheek flaps 182
Nasolabial flaps 183
The forehead flap 185
Nasal Support 191
Design of Grafts for Support 191
Materials for Support 193
Reconstruction of Nasal Lining 194
Facial Flaps 194
Skin Grafts for Nasal Lining 194
Intranasal Flaps 195
Free Tissue Transfer for Restoration of the Nasal Lining 195
References 198
11 Extremity Reconstruction 201
Diagnostic Work-Up 201
Tumor Extirpation 202
Limb Salvage Versus Amputation 203
Resection Margins 203
Limb Reconstruction 205
Reconstructive Goals 205
Reconstructive Principles 206
Soft-Tissue Reconstruction 206
Free Tissue Transfer 206
Functional Reconstruction 208
Bone Defects 208
Lower Extremity Reconstruction 209
Thigh 209
Knee 210
Lower leg 210
Foot and ankle 211
Reconstruction of the Upper Extremity 212
Shoulder and upper arm 213
Elbow 215
Forearm 215
Hand 216
Pediatric Consideration 218
Considerations in the Elderly 218
References 218
12 Abdominal Wall Tumors and Their Reconstruction 226
Introduction 226
Abdominal Wall Tnmor Resection and Reconstruction 226
Neoplasms of the Abdominal Wall 226
Anatomy and Physiology of the Abdominal Wall 228
Reconstruction of the Abdominal Wall 229
The Planning of How to Close the Internal Abdominal Wall 229
Adequate soft tissues above and below the mesh 230
Adequate soft tissues above the mesh, clean wound, but inadequate soft tissues below 230
Inadequate soft tissues above and adequate soft tissues below the mesh 230
Inadequate soft tissues above and below the mesh, or a contaminated surgical field 231
The Planning of How to Close the Skin 231
Midline Defects 234
Conclusion 235
References 235
13 Reconstruction of the Intra-Abdominal Pelvis and the Perineum 237
Introduction 237
Reconstruction of the Intra-Abdominal Pelvis 237
Rectal Cancer 238
Perineal Reconstruction 242
Vaginal Reconstruction 242
Perineal Skin Reconstruction 244
Anal/Buttock Skin Reconstruction 245
Conclusion 247
References 247
14 Management of Chemotherapeutic Agent Extravasation and Radiation Therapy Adverse Effects 248
Introduction 248
Chemotherapy Extravasation Injury 248
Incidence and Agents Associated with Extravasation Injury 248
Pathophysiology 249
Agent factors 249
Administration of therapy factors 250
Patient factors 250
Site of access factors 250
Recognizing Extravasation and Record Keeping 251
Recognizing the injury 251
Keeping track of the injury 251
Medical Treatment Options 252
Immediate interventions 252
Subsequent interventions 252
Antidote treatment 252
Surgical Treatment Options 253
Prevention of Extravasation Injury 254
Clinical and Pre-Clinical Research 254
Radiation Therapy Adverse Effects 255
Introduction 255
Recognizing the Problems and Classifying Injuries 255
Clinical Manifestations 256
Acute effects 256
Consequential effects 256
Late effects 257
Factors Affecting Radiation Injuries 257
Agent factors 257
Patient factors 257
Pathiophysiology and Mechanism of Radiation-Induced Damage 258
Introduction 258
Molecular and cellular response to radiation 258
Vascular effects 258
Recognizing Radiation-Induced Effects 259
Early skin effects 259
Late skin effects 259
Effects on wound healing 259
Treatment of Radiation Damage 259
Treatment for acute effects 259
Subsequent treatment 260
Treatment specifics 260
Hyperbaric oxygen treatment 260
Surgical treatment 261
Site-Specific Effects of Radiation Treatment 261
Breast cancer 261
Head and neck cancer 262
Research 263
Conclusion 263
References 264
Index 269