HEAD AND NECK RECONSTRUCTION WITH MAJOR REGIONAL FLAPS; WHAT THE COVID-19 PANDEMIC TAUGHT US

Objectives The aim of this study was to record the patients with advanced head and neck cancer who received a major regional flap for reconstruction in the COVID-19 pandemic period. Materials and Methods The surgical registry of a single centre was retrospectively searched for identification of patients who met the inclusion criteria of receiving a major regional flap for head and neck reconstruction, after resection of a locally advanced tumour, during the COVID-19 pandemic. The period recorded on this study as March 2020 to February 2021. All data available were recorded (tumour type, staging, operation, reconstruction) as well as post-operative follow up until up to date. Results 10 patients met the inclusion criteria. Mean age was 71.9 years old. 6 patients were newly diagnosed patients, whereas 4 were patients with recurrence. As far as staging is concerned, all had stage IV cancers, whereas 6 patients had T4 tumours, 2 T3 and 2 Tx. The latter 2 concern a patient with an occult neck mass of unknown origin and a patient with parotid adenocarcinoma. 4 patients were reconstructed with pectoralis major flap, 4 patients with cervicothoracic flaps, 1 with cervicofacial flap and 1 with deltopectoral flap. All immediate post-operative periods were uneventful but one, who presented a localized hematoma which required drainage. 5 patients appeared with a recurrence in the follow-up period of the first year and did not survive. The rest are surviving disease free with a mean follow-up period of 1.5 years. Conclusion Major regional flaps remain a valid alternative for head and neck reconstruction in patients with advanced head and neck cancer. The COVID-19 pandemic reduced the available human and technical resources for other types of flap reconstructions, forcing the use of regional flaps as the treatment of choice for advanced patients.