O-3507 RECONSTRUCTION OF CRANIAL AND CRANIAL BASE DEFECTS USING PEDICLED FLAPS VERSUS FREE FLAPS AFTER TUMOUR RESECTION

Objective. The harvesting of local flaps is the gold stan- dard to reconstruct craniofacial or cranial base defects after ablative cancer surgery. A second effective recon- structive method, when defects are larger or local tissue conditions prevent to use local flaps is represented by free flaps, such as latissimus dorsi, forearm, anterolateral thigh ones. Traditional pedicled flaps (as latissimus dorsi, pec- toralis major, deltopectoral, superior trapezius, lower island trapezius myocutaneous flaps) are commonly the last reconstructive choice because their distal tissues (gen- erally located into the third angiosome) may by lost be- cause of poor vascularization. That may lead to fistulae, infections and life threatening complications. However, in some selected cases, pedicled flaps become an important surgical option. That is the case of patients previously treated with radiotherapy or with poor general health conditions (diabetes mellitus, hypertension, severe vascu- lophaty). Methods. Between 2007 and 2012, 7 head and neck pedi- cle flap reconstruction procedures were carried out among our Maxillo-facial and Neurosurgical teams. The patients (4 females, 3 males) were affected by cranial or cranial base tumours. The histology was infiltrating basal cell carcinoma of the temporal region and scalp in 2 cases, squamous cell carcinoma of the occipital and parietal regions in 2 case, bone and soft tissue defects after abla- tive neurosurgery in 3 cases. The defect size ranged from 15 to 25 cm of major diameter. Three patients were recon- structed with pedicled latissimus dorsi muscolocutaneous flap, two with pectoralis major flap, two with lower island myocutaneous trapezius flap. All patients included in the study have previously under- gone radiotherapy or were affected by systemic diseases which could impair the success of a local or microvascular flap. Results. No patients had significant post-operative compli- cations. No total nor partial flaps failure occurred. The morbidity related to this technique was acceptable, with poor functional sequelae and great acceptance by all pa- tients. Four patients have shown reduced motor function of the upper limbs, so they underwent physiotherapy with great functional improvements. Conclusions. The use of pedicled flaps may offer a safe option in selected cases, offering some advantages such as a shorter duration of the procedure, a shorter hospitaliza- tion and reduction of post-operative complication.