Abstract
The standard of care for head and neck reconstruction is microvascular free-tissue
transfer. Various techniques of soft tissue, free-flap design have previously been
described. Patient-specific planning and 3D printing have changed practice in bony
reconstruction, but are not currently used in soft tissue head and neck reconstruction.
We present the first report of Personalised pAtient-specific plaNning of SOFt tissue recOnStruction, the “PANSOFOS” flap, and aim to prove that the technique has a place in
soft tissue reconstruction of the head and neck. Using the IDEAL framework for the
reporting of surgical innovations (IDEAL stage 1, proof of concept report), we describe
the case of a patient with oral cancer who had reconstruction of the tongue after
hemiglossectomy. The staging scans, 3D printer and software were used to create a
soft silicon resection guide and flap harvesting guide. The 3D guide was then used
to design a 2D outline of the perimeter of the flap, and a negative silicone mould
used to control its bulk. The procedure was successful and the postoperative period
uneventful. The oncological, cosmetic, and functional outcomes were excellent. The
patient followed the local enhanced recovery pathway and was discharged home with
safe swallowing. This report confirms that patient-specific 3D planning can be used
in the reconstruction of soft tissue defects of the head and neck. We aim to develop
the technique using the next stages of the IDEAL framework, and anticipate that the
PANSOFOS flap will become a standard of care.
Keywords
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to British Journal of Oral and Maxillofacial SurgeryAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Global epidemiology of oral and oropharyngeal cancer.Oral Oncol. 2009; 45: 309-316
- Head and neck reconstruction.Plast Reconstr Surg. 2013; 131: 260e-269e
- Updates in head and neck reconstruction.Plast Reconstr Surg. 2018; 141: 271e-285e
- Modern radiotherapy for head and neck cancer.Semin Oncol. 2019; 46: 233-245
- Radiation oncology for head and neck cancer: current standards and future changes.Oral Maxillofac Surg Clin North Am. 2019; 31: 31-38
- Chemotherapy in locally advanced head and neck squamous cell carcinoma.Cancer Treat Rev. 2016; 44: 10-16
- Quality of life for head and neck cancer patients--has treatment planning altered?.Oral Oncol. 2009; 45: 435-439
- Quality of life perspectives in patients with oral cancer.Oral Oncol. 2010; 46: 445-447
- The physical function and social-emotional function subscales of the University of Washington Quality of Life Questionnaire.Arch Otolaryngol Head Neck Surg. 2010; 136: 352-357
- Rectangle tongue template for reconstruction of the hemiglossectomy defect.Arch Otolaryncol Head Neck Surg. 2008; 134: 993-998
- Impact of 3D virtual planning on reconstruction of mandibular and maxillary surgical defects in head and neck oncology.Curr Opin Otolaryngol Head Neck Surg. 2018; 26: 108-114
- Principles and practice of reconstructive surgery for head and neck cancer.Surg Oncol Clin N Am. 2015; 24: 473-489
- Applications and limitations of using patient-specific 3D printed molds in autologous breast reconstruction.Eur J Plast Surg. 2018; 41: 571-576
- DIEP flap breast reconstruction in patients with breast ptosis: 2-stage reconstruction using 3-dimensional surface imaging and a printed mold.Plast Reconstr Surg Glob Open. 2017; 5: e1511
- No surgical innovation without evaluation: the IDEAL recommendations.Lancet. 2009; 374: 1105-1112
- No surgical innovation without evaluation: evolution and further development of the IDEAL framework and recommendations.Ann Surg. 2019; 269: 211-220
- Acland’s practice manual for microvascular surgery.3rd ed. The Indian Society for Surgery of the Hand (ISSH), 2008
- Improving outcomes in head and neck cancers: the manual.National Institute for Clinical Excellence, 2004
- Head and neck cancer: United Kingdom national multidisciplinary guidelines.The Journal of Laryngology & Otology. 2016; 130 (Available from URL: https://www.bahno.org.uk/_userfiles/pages/files/ukheadandcancerguidelines2016.pdf (last accessed 7 April 2020)): S2-S4
- Long-term functional outcomes after total tongue reconstruction: consideration of flap types, volume, and functional results.Microsurgery. 2017; 37: 190-196
- Microvascular reconstruction of the tongue using a free anterolateral thigh flap: three-dimensional evaluation of volume loss after radiotherapy.J Craniomaxillofac Surg. 2016; 44: 1287-1291
- Optimizing outcomes following total and subtotal tongue reconstruction: a systematic review of the contemporary literature.J Reconstr Microsurg. 2017; 33: 103-111
- Modification of flap design for total mobile tongue reconstruction using a sensitive antero-lateral thigh flap.J Plast Reconstr Aesthet Surg. 2012; 65: e169-74
- Head and neck soft tissue reconstruction with anterolateral thigh flaps with various components: development of an algorithm for flap selection in different clinical scenarios.Microsurgery. 2019; 39: 590-597
- Reconstruction of the maxilla and midface: introducing a new classification.Lancet Oncol. 2010; 11: 1001-1008
Article info
Publication history
Published online: April 26, 2020
Identification
Copyright
Crown Copyright © 2020 Published by Elsevier Ltd on behalf of The British Association of Oral and Maxillofacial Surgeons. All rights reserved.
