Synergistic reconstruction of a cervicofacial defect using a free-tissue transfer and a prosthesis.

A 78-year-old man presented with squamous cell carcinoma of the right cervicofacial skin. The tumor had invaded the deep planes of the neck and distorted the auricle (figure, A). The patient initially opted for primary radiotherapy, but it failed to eradicate the disease. He subsequently underwent a salvage resection, which included a wide local excision of the cervical skin, a total parotidectomy, a total auriculectomy, and an ipsilateral modified radical neck dissection. This surgery left the patient with a significant cosmetic deformity.

[FIGURE A OMITTED]

Reconstruction was performed in a staged fashion, combining the use of a free-tissue transfer and prosthetic rehabilitation. Postablation, with negative tissue margins for cancer, a large radial forearm fasciocutaneous paddle was harvested and used to resurface the right cervicofacial region (figure, B). Four months later, after the flap edema had resolved and the flap surface had matured, a prosthetic auricle was constructed (figure, C).

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Oftentimes, reconstruction efforts for head and neck cancer patients involve only a single surgeon--either a free-flap surgeon or a prosthodontist. The case described herein is an example of a situation in which a patient was able to achieve the best cosmetic outcome as a result of a collaborative approach. Although there was a slight mismatch in color in this case, the overall appearance was dramatically improved.

Ryan F. Osborne, MD

From the Head and Neck Cancer Center, Cedars-Sinai Medical Center, Los Angeles.