Microvascular Reconstruction
History
Current treatment in head and neck cancer is based primarily on combined therapy, which includes radiation therapy, surgery, and chemotherapy. Orthovoltage radiation therapy was the mainstay of head and neck cancer treatment until the 1940s. Advances in the field of anesthesia and new, safer techniques in surgery led to the current combination of therapy offered to patients with cancer of the head and neck. The defects created with these advanced techniques at the time of surgery for head and neck cancer have led to advances in reconstruction. A brief history of these developments is provided below.

Before 1963, oral and pharyngeal defects were closed primarily and reconstructed with random pattern skin flaps or tubed-pedicled flaps of skin from the trunk.

In 1963, McGregor first described the forehead flap.

In 1965, Bakamjian first described the deltopectoral flap.

In 1979, Ariyan described the pedicled pectoralis major myocutaneous flap, which became the predominant method for reconstruction in head and neck cancer.

In the early 1980s, Demergasso, Piazza, Panje, and Baek described the trapezius flap and its modifications for head and neck reconstruction.

Tansini first described the latissimus dorsi flap in 1896 as a method for chest wall reconstruction after mastectomy. Quillen and Shearin demonstrated the application in head and neck reconstruction.

In 1973, Daniel and Taylor reported the first free flap, the transplant of an autologous skin flap to the lower extremity using the operating microscope.

In 1976, Panje and Harashina simultaneously described the use of free flaps to reconstruct defects of the oral cavity.

In the late 1980s and early 1990s, the use of osteocutaneous free flaps to reconstruct mandibular defects was advanced.
Frequency

According to American Cancer Society statistics for the year 2000, new cases of cancer of the head and neck are estimated at 30,200 for cancer of the oral cavity and pharynx and at 10,100 for cancer of the larynx. Deaths from cancer of the oral cavity and pharynx are estimated at 7800; deaths from cancer of the larynx are estimated at 3900.