الفهرس 
IntroductionOnly 14 pages are availabe for public view
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Abstract
Although advances in radiotherapy and chemotherapy for cancers of the head and neck have been remarkable, surgical resection followed by reconstructive surgery is still the mainstay of treatment. Of the reconstructive procedures, microsurgical tissue transfer has been considered the standard method for restoring postoperative functions and morphology.
The reconstruction ladder consists of multiple steps starting from the simplest to the most complex option. As a general rule, when planning an individual patient’s reconstruction,attempt the least complex and safest option from the reconstructive ladder first, while maintaining form and function. The plastic surgeon should be comfortable with the full armamentarium of reconstructive techniques, and should be able to decide which technique is the best for each particular patient and defect.
Head and neck reconstruction is an extremely demanding process that needs continues improvements and refinements. Patients’ cases should be managed with a team approach, including oncologists, ablative surgeons, and reconstructive surgeons. Despite the progress achieved in this field, frustration of head and neck reconstruction remains because of the inability to attain complete functional and cosmetic recovery with current techniques.
In recent years, free flaps have become the workhorse in head and neck reconstruction; most centers are reporting success results higher than 96% with the possibility of free flap salvage for failures. A competent reconstructive surgeon should be familiar with the armamentarium available
for reconstruction, understanding the advantages and limitation of each technique and knowing when and where to adopt each one.
Reconstruction of different parts of head and neck requires techniques differs from part to part according to structure ,function and aesthetic subunits.
The argument for secondary reconstruction was primarily centred on the concern that reconstructed tissue can delay detection of recurrence. In addition, during the era of pedicled flaps and multi-stage reconstruction, there was concern of delay in implementing the essential postoperative radiotherapy required for optimal control of the disease. Previously the multi-stage reconstruction often extended beyond the optimal period of initiation of adjuvant radiotherapy which is six weeks after completion of surgery.
With the availability of reliable single-stage reconstructive procedures and the often-practiced two-team approach, head and neck reconstruction can be performed expeditiously and with predictable outcome. Improved quality of like with primary reconstruction is now considered and overriding argument for primary reconstruction. Availability of high-definition anatomic and metabolic imaging studies also facilitates detection of local recurrence and counters the argument to delay reconstruction.
Secondary reconstruction has almost become obsolete with a few exceptions. In circumstances when there is lack of microvascular surglical expertise or due to inherent patient factors, it may still be necessary to employ alternative methods of reconstruction and /or delay definitive reconstruction.
In reconstruction of head and neck defects after cancer resections the traditional concept of the reconstructive ladder has now been replaced with the concept of reconstructive elevator or reconstructive escalator in this concept there is no need to strictly follow the reconstructive ladder of considering the simpler procedures first and then escalating to complex procedures but rather to choose the most appropriate technique as the initial procedure choice of reconstructive options depends on various factors such as site of the defect type of tissue required function and cosmetic implication of the defect associated co-morbidity and availability of resources in most head and neck defects there is often an ideal reconstruction option this however needs to be selected based on the factors related to the anatomical and functional defect and also based on the patient factors and available expertise.
The concept of primary reconstruction of head and neck cancer surgery defects began with the advent of deltopectoral forehead and pectoralis major myocutaneous flaps. For years pectoralis major major myocutaneous flap has been the workhorse for reconstruction of a variety of defects in the head and neck region atissiumus dorisi trapezius platysma myocutaneous flaps are the other less utilized pedicled flaps However all these flaps have limitations firstly they have a limited reach cause of which there are more chances of distal flap failure and wound gape due to tension by the downward pull of the flaps. Secondly the type of tissue in the flap its bulk and pliability does not always suit the defect to be reconstructed. Thirdly it may not be possible to contour the flap to the defect in different planes the that of the pedicled flap.
:ﻢﯿﻣﺮﺘﻠﻟ ﺔﻣﺎﻌﻟا ﻢﯿھﺎﻔﻤﻟا
ﻢﯿﯿﻘﺗ ﻞﺟا ﻦﻣ
ﻢﯿﻣﺮﺗ
حاﺮﺟو
ماروأ
حاﺮﺟ
,ماروأ
ﺐﯿﺒط
ﻦﻣ ﻖﯾﺮﻓ
ﺐﻠﻄﺘﯾ
ﺢﺟﺎﻨﻟا
ﻢﯿﻣﺮﺘﻟا
.جﻼﻌﻟا ﺔﻄﺧ ﻞﻤﻋو ﺔﯿﻠﻤﻌﻟا ﻞﺒﻗ ﻖﯿﻗد
ﺔﻤﺋﻼﻤﻟا ءاﺰﺟﻻا ﺮﻓاﻮﺗ , ضﺮﻤﻟا ﺮﯿﺴﺑ ﺆﺒﻨﺘﻟا , مرﻮﻟا
ﺔﻠﺣﺮﻣ ﻞﺜﻣ ﺔﻣﺎھ تارﺎﺒﺘﻋا ﺪﺟﻮﺗ
.ﺔﯿﺴﻔﻨﻟا ﺾﯾﺮﻤﻟا ﺔﯿﻨﺑ و
ﺔﺣﺎﺘﻤﻟا ﺐھﻮﻟا ﻦﻛﺎﻣأ ,ﻢﺴﺠﻟا ﺔﻟﺎﺣ ,ﮫﺴﻨﺟ ,ﺾﯾﺮﻤﻟا ﺮﻤﻋ, ﻢﯿﻣﺮﺘﻠﻟ
اﺪﯿﻘﻌﺗ ﺮﺜﻛﻻا ﻲﺘﺣو ﻂﺴﺑﻻا ﻦﻣ :ﻢﯿﻣﺮﺘﻟا ﻢﻠﺳ
.يﻮﻧﺎﺜﻟا مﺎﺌﺘﻟﻻا .1
.ئﺪﺒﻣ ﻖﻠﻏ .2
(ﺔﯿﻠﻛ ﺔﻛﺎﻤﺳ ,ﺔﯿﺋﺰﺟ ﺔﻛﺎﻤﺳ) يﺪﻠﺟ ﻊﯿﻗﺮﺗ .3
.ﺐﻛﺮﻣ ﻊﯿﻗﺮﺗ .4
.ﺔﯿﻌﺿﻮﻣ ﺔﻠﯾﺪﺳ .5
.ﺔﯿﺼﻗ ﺔﯿﻘﻨﻋ ﺔﻠﯾﺪﺳ .6
.ﺮﺤﻟا ﺞﯿﺴﻨﻟا ﻞﻘﻧ .7
ﻢﯿﻣﺮﺘﻟا ﻲﻓ مﺪﺨﺘﺴﺗ مﻮﯿﻧﺎﺘﯿﺘﻟا وأ نﻮﻜﻠﯿﺳ ,ﻲﻣﺎﺴﻣ ﻦﯿﻠﯿﺜﯾا ﻲﻟﻮﺑ ﻞﺜﻣ ﺔﻌﻨﺼﻤﻟا داﻮﻤﻟا
.مﺎﻈﻌﻟا وا ﻲﻠﻜﯿﮭﻟا
ظﺎﻔﺤﻟا ﻊﻣ ﻢﯿﻣﺮﺘﻟا ﻢﻠﺳ ﻦﻣ ﻦﻣﻻا رﺎﯿﺨﻟاو ًاﺪﯿﻘﻌﺗ ﻞﻗﻻا رﺎﺘﺨﻧ ﻂﯿﻄﺨﺘﻟا ﺪﻨﻋ , ﮫﻣﺎﻋ ةﺪﻋﺎﻘﻛ
.ﺔﻔﯿظﻮﻟاو ﻞﻜﺸﻟا ﻲﻠﻋ
ﺔﯾﺎﻔﻛ , ﻢﯿﻤﺼﺘﻟا ﻲﻓ عﻮﻨﺘﻟا :ﻲﺗﻻا ﻲﺒﻠﺗ نأ ﺪﺑﻻ ﻖﻨﻌﻟاو سأﺮﻟا ﻢﯿﻣﺮﺘﻟ ﺔﯿﻟﺎﺜﻤﻟا ﺔﻠﯾﺪﺴﻟا
مﺪﻋو ﻦﻣاو ﻞﮭﺳ ﻞﺼﻓ ,ﺮﯿﺒﻛو ﻞﯾﻮط ﻖﻨﻋ ,ﺐﺼﻌﺘﻟا ةدﺎﻋﻻ ﺔﯿﻠﺑﺎﻘﻟا , ﺔﺒﺳﺎﻨﻣ ﺔﯿﻨﺑ ,ﺞﯿﺴﻨﻟا
.ﺢﻧﺎﻤﻟا ءﺰﺠﻠﻟ تﺎﻔﻋﺎﻀﻣ ثوﺪﺣ
ﺔﺑﺎﺸﺘﻟ ﺔﺒﻛﺮﻤﻟا ﺔﺠﺴﻧﻻا ﺔﯿﻤﻛ, ﺔﺣﺎﺘﻤﻟا ﺔﺠﺴﻧﻻا عاﻮﻧا ﻲﻓ عﻮﻨﺘﻟﺎﻛ ﺎﯾاﺰﻣ ﮫﻟ :ﺮﺤﻟا ﺞﯿﺴﻨﻟا ﻞﻘﻧ
يرﻮﻔﻟا ﻢﯿﻣﺮﺘﻟاو ﺞﯿﺴﻨﻠﻟ ﻞﺜﻣا ماﺪﺨﺘﺳا ,ﺢﻧﺎﻤﻟا ﺪﻠﺠﻟا صاﻮﺧ ﻲﻓ عﻮﻨﺘﻟا ,ﻞﺻﻻا
:ﺔﯿﺤﻄﺴﻟا ﺔﺠﺴﻧﻻا ﻢﯿﻣﺮﺗ
ﺔﯿﻨﺑو ﻚﻤﺳ ,نﻮﻟ ﻲﻠﻋ ظﺎﻔﺤﻟا ﻊﻣ دﻮﻘﻔﻤﻟا ءﺰﺠﻟا ﻖﻠﻏ ﺐﺠﯾ . ﻢﯿﻣﺮﺘﻟا ﻢﻠﺴﺑ ﺪﻠﺠﻟا ﻢﯿﻣﺮﺗ ﻦﻜﻤﯾ
.ﺪﻠﺠﻟا
ﺔﯿﻠﯿﻤﺠﺘﻟا ﺞﺋﺎﺘﻨﻟا ﻞﻀﻓا ﻲﻄﻌﯾ ﺔﯿﻌﺿﻮﻤﻟا ﺔﻠﯾﺪﺴﻟاو ﻂﯿﺴﺒﻟا ﻖﻠﻐﻟﺎﺑ ﻢﯿﻣﺮﺗ :ةﺮﯿﻐﺼﻟا بﻮﯿﻌﻟا
.ﺔﻌﻗﺮﻟا ﺺﻠﻘﺗو نﻮﻠﻟا ﻒﻠﺘﺨﻟ ﺐﺳﺎﻨﻣ ﺮﯿﻏ ﻊﯿﻗﺮﺘﻟا.ﺔﯿﻔﯿظﻮﻟاو
.ةﺮﯿﺒﻛ ﺔﯿﻌﺿﻮﻣ ﺔﻠﯾﺪﺳ :ﺔﻄﺳﻮﺘﻤﻟا بﻮﯿﻌﻟا
ﺢﻤﺴﺗو ﺔﻧﺮﻣو ﺔﻌﯿﻓر ﺎﮭﻧﻮﻜﻟ ةﺪﯿﺟ ﺬﺨﻔﻟا وأ ﺪﻀﻌﻟا ﻦﻣ ةﺮﺣ ﺔﻠﯾﺪﺳ :ةﺮﯿﺒﻜﻟا بﻮﯿﻌﻟا
.ﮫﺟﻮﻟا ﻞﻜﯿھ ﻲﻠﻋ ﻞﻜﺸﺘﻟﺎﺑ
ﺖﺴﯿﻟ
ﺎﮭﻨﻜﻟ ﻖﻨﻌﻟا ﻢﯿﻣﺮﺗ ﻲﻓ وا ةﺮﺤﻟا
ﺔﻠﯾﺪﺴﻟا ﻞﺸﻓ ﺪﻌﺑ ﮫﻣاﺪﺨﺘﺳا ﻦﻜﻤﯾ :ﺔﯿﺼﻗ ﺔﯿﻘﻨﻋ ﺔﻠﯾﺪﺳ
.ﮫﺟﻮﻟا ﻢﯿﻣﺮﺗ ﻲﻓ ماﺪﺨﺘﺳﻼﻟ ﺔﯿﻟﺎﺜﻣ
ﻖﻨﻌﻟاو سأﺮﻟا ﺔﻘﻄﻨﻣ ﺐﺳﺎﻨﯾ ﻲﻟﺎﺜﻣ ماﻮﻗو نﻮﻟ ﺎﮭﻟو ﺔﻌﯿطو ﺔﻌﯿﻓر :ﺔﯾرﺪﺼﻟا ﺔﯿﻟاﺪﻟا ﺔﻠﯾﺪﺴﻟا
تﺎﯿﻠﻤﻌﻟا ﻊﻣ ﺔﺻﺎﺧ ةﺮﯿﺒﻛ ﺔﻠﯾﺪﺳ ﺪﺼﺣ ﻦﻣ ﻦﻜﻤﯾو ﻊﯾﺮﺳ ﺪﺼﺣ ﻞﮭﺴﯾ ﺎﮭﺤﯾﺮﺸﺗ تﺎﺒﺛ
.ﮫﺋﺎﻐﻟإ ﻦﻜﻤﯾو ﺢﻧﺎﻤﻟا نﺎﻜﻤﻟا ﺔﻔﯿظﻮﺑ ﻂﯿﺴﺑ ﺐﯿﻋ ﺞﺘﻨﯾو .ةﺮﺧﺄﺘﻤﻟا
ﻲﻓ يﺪﺤﺘﻟا.ﺮﻤﺘﺴﻤﻟا ﻦﯿﺴﺤﺘﻠﻟ جﺎﺘﺤﺗو ﺔﺟرد ﻰﺼﻗﻻ ﺔﺒﻠﻄﺘﻣ ﺔﯿﻠﻤﻋ ﻮھ :ﻖﻨﻌﻟا و سأﺮﻟا ﻢﯿﻣﺮﺗ •
.ﺔﻔﯿظﻮﻟا ةدﺎﻌﺘﺳا ﻦﻜﻟو ﺔﯿﻠﯿﻤﺠﺘﻟا ﺔﺠﯿﺘﻨﻟا ﻂﻘﻓ ﺲﯿﻟ ﻢﯿﻣﺮﺘﻟا
ﺔﯿﻨﻘﺗ ﻞﻛ ﺔﯾدوﺪﺤﻣو تاﺰﯿﻤﻣ ﻢﮭﻔﺘﯾو ﺔﺣﺎﺘﻤﻟا تارﺎﯿﺨﻟا دﺎﺘﻌﯾ نأ ﺐﺠﯾ ءﻒﻜﻟا ﻢﯿﻣﺮﺘﻟا حاﺮﺟ •
.ﺎﮭﻣﺪﺨﺘﺴﯾ ﻦﯾأو ﻲﺘﻣ فﺮﻌﯾو