[Combined surgical flaps for simultaneous reconstruction of the tongue, mouth floor and pharynx in expanded glossectomy within the scope of multi-modal treatment of squamous epithelial cancers of UICC stage IV].

Multimodal approach and improved surgical techniques enable the head and neck surgeon to operate even far advanced tumours of the head and neck under curative intention. Microanastomosed distant flaps and intestinal grafts expanded the operative spectrum while having the disadvantages of being time-consuming and in most cases the necessity to call for the specialist (e.g. the abdominal, vascular surgeon). In 6 cases of total glossectomy combined with hemipharyngectomy and hemimandibulectomy the possibilities of closing large defects by combined regional and pedicled flaps in the head and neck area are shown. In all of our cases surgical therapy had been placed at the end of therapeutic interventions in a multimodal treatment protocol. Treatment started with induction chemotherapy with a regimen including cisplatin, bleomycin and vindesin sulfate and was followed by a subsequent radiotherapy reaching a total reference dose of 60 to 70 Gy. After radiotherapy 5 patients received adjuvant chemotherapy of 1-4 cycles. Despite the aggressive presurgical treatment, the postoperative complications were minor. In a median survival of 37.5 months there were 3 recurrences, 2 patients died of tumour progression. All of our patients benefited from of the "salvage-operation" especially with regard to tumour pain. Quality of the patients' life could be improved upon by percutaneous endoscopic gatrostomy (PEG) and as well good functional and cosmetic results of the surgical reconstructions. The results justify the discussion about a palliative indication of extended surgical procedures and reconstructive surgery in far advanced head and neck cancer in the course of a multimodal treatment regimen.