Skip to main content
AAO-HNSF 2023 Annual Meeting & OTO Experience Main banner
Icon Legend
This session is not in your schedule.
This session is in your schedule. Click again to remove it.

Facial Plastic and Reconstructive Surgery

Thinking Outside the Free Flap Box for Large Cutaneous Defects

Tuesday, October 3, 2023
1:45 PM - 2:35 PM East Coast USA Time
Location: Ballroom A1

    Moderator(s)

  • Brittny N. Tillman, MD, FACS

    Associate Professor, Fellowship Director, Department Of Otolaryngology, Division of Head and Neck Oncology
    UT Southwestern Medical Center
    Dallas, TX, United States

    • Panelist(s)

  • Brittny N. Tillman, MD, FACS

    Associate Professor, Fellowship Director, Department Of Otolaryngology, Division of Head and Neck Oncology
    UT Southwestern Medical Center
    Dallas, TX, United States

  • Tiffany A. Glazer, MD, FACS

    Associate Professor / Residency Program Director
    University of Wisconsin
    Madison, WI, United States

  • SM

    Scott A. McLean, MD PhD

    Associate Professor
    University of Michigan
    Ann Arbor, MI, United States

  • RP

    Rusha J. Patel, MD

    Associate Professor
    University of Oklahoma Health Sciences Center
    Oklahoma City, OK, United States

Disclosure(s):
Rusha J. Patel, MD: No relevant relationships to disclose.
PROGRAM DESCRIPTION: The emergence of the free flap in the 1970’s revolutionized head and neck reconstruction changing both reconstructive and treatment paradigms. With time, we have become more comfortable and reliant on these flaps while often abandoning prior techniques and exploration of loco-regional reconstructive options. At this point it’s important to ask ourselves – when does the pendulum swing too far?

Cutaneous malignancy is the most common type of cancer in the United States and rising owing to many factors including an aging baby boomer population and higher incidence of immunosuppression. Many of these cases are presenting as higher risk primaries in advanced stages leading to larger Mohs and surgical defects. This population often presents with a special set of considerations including advanced age, numerous comorbidities, cognitive decline, inability to travel, and lack of caregiver support.

Benefits to loco-regional reconstruction over free tissue include shorter hospitalization, no need for microvascular expertise, no need for intensive care, decreased cost, and decreased complication rates. In general, we find that in following the reconstructive ladder, perhaps less truly is more in the right setting.

OUTCOME OBJECTIVE 1: Describe the rationale and cutaneous patient population suited for loco-regional reconstruction that may otherwise be reconstructed with free tissue.

OUTCOME OBJECTIVE 2: Recognize borderline cutaneous defects that are amenable to loco-regional reconstruction over free tissue, including those undergoing adjuvant radiation.

OUTCOME OBJECTIVE 3: Demonstrate case-based examples of large cutaneous defects reconstructed with creative loco-regional flaps that may otherwise have undergone free tissue transfer.

BACKGROUND STATEMENT: With a growing cutaneous malignancy population who may not have access to or be optimal candidates for free tissue transfer it is beneficial to explore alternative methods of reconstruction which may in turn lead to shorter hospitalization, decreased costs, and ultimately improved care.