Microsurgical composite reconstruction in head and neck and esophagus.

This paper describes-the indications for, the main points of the surgical technique, and the results of composite reconstruction using a combination of pediculated and free tissue units, which has allowed extensive and complex reconstruction following resection of malignant tumors in the head and neck region or in the esophagus. Composite reconstruction was indicated for synchronous or metachronous carcinomas in the head and neck region and the esophagus (Groups 1 and 2) or for secondary reconstruction of the esophagus (Group 3). In most cases, the gastric tube or colon was used as pediculated tissue, and the jejunum, forearm flap, or rectus abdominis flap were used as free tissue. Total necrosis of the transplanted jejunum occurred in two patients and leakage in five, most of whom were in Group 3. Although the prognosis was extremely poor in Groups 1 and 3 because of the advanced cancer stage, composite reconstruction permitted oral feeding, which proved beneficial from the viewpoint of the patient's quality of life.