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Reconstructive Techniques in Transoral Robotic Surgery for Head and Neck Cancer: A North American Survey

Konofaos, Petros M.D., Ph.D.; Hammond, Sarah M.D.; Ver Halen, Jon P. M.D.; Samant, Sandeep M.D.

Plastic and Reconstructive Surgery: February 2013 - Volume 131 - Issue 2 - p 188e–197e
doi: 10.1097/PRS.0b013e3182778680
Reconstructive: Head and Neck: Original Articles

Background: Although the use of transoral robotic surgery for tumor extirpation is expanding, little is known about national trends in the reconstruction of resultant defects.

Methods: An 18-question electronic survey was created by an expert panel of surgeons from the Department of Otolaryngology–Head and Neck Surgery and the Department of Plastic and Reconstructive Surgery at the University of Tennessee. Eligible participants were identified by the American Head and Neck Society Web site and from the Intuitive Surgical, Inc., Web site after review of surgeons trained in transoral robotic surgery techniques.

Results: Twenty-three of 27 preselected head and neck surgeons (85.18 percent) completed the survey. All respondents use transoral robotic surgery for head and neck tumor extirpation. The majority of the respondents [n = 17 (77.3 percent)] did not use any means of reconstruction. With respect to methods of reconstruction following transoral robotic surgery defects, the majority [n = 4 (80.0 percent)] used a free flap, a pedicled local flap [n = 3 (60.0 percent)], or a distant flap [n = 3 (60.0 percent)]. The radial forearm flap was the most commonly used free flap by all respondents.

Conclusions: In general, the majority of survey respondents allow defects to heal secondarily or close primarily. Based on this survey, consensus indications for pedicled or free tissue transfer following transoral robotic surgery defects were primary head and neck tumors (stage T3 and T4a), pharyngeal defects with exposure of vital structures, and prior irradiation or chemoradiation to the operative site and neck.

Memphis, Tenn.

From the Departments of Plastic Surgery, General Surgery, and Otolaryngology–Head and Neck Surgery, University of Tennessee.

Received for publication June 2, 2012; accepted August 9, 2012.

Disclosure:The authors have no financial interest to declare in relation to the content of this article.

Jon P. Ver Halen, M.D.; Department of Plastic Surgery, University of Tennessee, 7945 Wolf River Boulevard, Suite 290, Germantown, Tenn. 38103,

©2013American Society of Plastic Surgeons