Abstract | March 2, 2021
Free Abdominal Tissue Transfer and Utilization of Umbilical Stalk for “Tubular” Reconstruction in Ear, Nose and Throat Defects: A Case Series
Learning Objectives
- Describe the application of abdominal based flaps for large head and neck burn reconstruction;
- Discuss the ability to use the umbilical stalk for a tubular structure reconstruction.
Introduction: Head and neck defects, whether from burns or cancer resections, are complex and often require free flap reconstruction. Radial forearm and anterolateral thigh (ALT) flaps are commonly used due to their thin and versatile nature. However, abdominal based free tissue transfer is one valuable alternative that can cover large defects and becomes a more appropriate option on the reconstructive ladder when the defect includes reconstruction of a tubular structure, such as the external auditory canal, a neck tracheostomy/stoma site or an external nasal opening. We present a novel utilization of abdominal free tissue transfer for coverage of large ear and scalp burn defects as well as neck and midface defects with usage of the umbilical stalk for tubed reconstruction.
Methods: Four patients presented for reconstruction: two had sustained large ear and scalp burns resulting in complete ear loss; one had a large neck defect from recurrent cancer resection which necessitated a laryngectomy and stoma creation; and one had a large central face defect post-cancer resection. All four patients underwent abdominal based free tissue transfer with reconstruction of the external auditory canal in the ear and scalp burns, stoma creation in the neck defect, and the external nasal opening in the central face defect, all utilizing the vascularized umbilical stalk for the tubed reconstruction.
Results: All patients recovered post-operatively without any reported complications such as tubular stenosis or contracture while maintaining umbilical stalk tubular patency.
Conclusion: Reconstruction of a tubed structure in head and neck defects, whether the external auditory meatus, an external nasal opening or a neck stoma post burn or cancer resection, can be a difficult and challenging operation fraught with potential complications. We present a successful method of reconstructing large defects employing the use of the uniquely thin and vascularized umbilical stalk for tubular reconstruction.
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