The role of free tissue transfer in the reconstruction of massive neglected XXXX of the @entity135 .

@entity1 @entity135 @entity5 @entity1489 @entity957 @entity3 @entity1491
BACKGROUND: Most @entity1489 involving the @entity135 region are easily managed with surgical resection and local flap rotation. Occasional @entity1 present with massive neglected @entity1489 or @entity1489 that have recurred after multiple treatments. Management of these massive @entity5 may involve craniofacial resection, maxillectomy, or mandibulectomy to obtain clear margins. Reconstruction requires massive composite soft tissue replacement. We presented our experience with, to our knowledge, the largest series reported to date. DESIGN: A retrospective chart review of 43 @entity1 with massive neglected @entity1489 of the @entity135 reconstructed by means of free tissue transfer from January 1, 1992, through October 1, 2001. SETTING: Academic tertiary referral medical center. RESULTS: Seventeen @entity1 with @entity957 and 26 @entity1 with @entity1491 were treated. Primary sites included the cheek (n = 15), ear (n = 8), forehead (n = 5), neck (n = 4), scalp (n = 5), and nose (n = 6). Treatment involved a combination of orbital exenteration (n = 16), maxillectomy (n = 12), mandibulectomy (n = 6), auriculectomy (n = 5), craniofacial resection (n = 10), rhinectomy (n = 6), and lateral temporal bone excision (n = 5). Flaps used for reconstruction included the rectus abdominis (n = 22), latissimus dorsi (n = 11), radial forearm (n = 8), and lateral arm (n = 2). Radiotherapeutic exposure included pretreatment in 21 @entity1 and posttreatment in 15. Twelve @entity1 had undergone no previous surgeries; 15 @entity1 , 1 to 5; and 16 @entity1 , more than 5. Follow-up revealed evidence of local recurrence (n = 12), locoregional recurrence (n = 3), distant @entity3 (n = 3), and no evidence of disease (n = 25). CONCLUSIONS: Massive @entity1489 are generally associated with disfiguring, debilitating surgery and high mortality rates. We demonstrate that free tissue transfer yields acceptable survival with functional and cosmetic outcomes.
