A combination of two regional flaps for the complex reconstruction after head and neck cancer surgery as an alternative approach during the COVID‑19 pandemic: A case report

Caruntu,Ana; Moraru,Liliana; Comaneanu,Raluca Monica; Costache,Raluca Simona; Farcasiu,Titus Alexandru; Scheau,Cristian; Costache,Daniel Octavian; Caruntu,Constantin

doi:10.3892/etm.2022.11291

A combination of two regional flaps for the complex reconstruction after head and neck cancer surgery as an alternative approach during the COVID‑19 pandemic: A case report

Authors:
- Ana Caruntu
- Liliana Moraru
- Raluca Monica Comaneanu
- Raluca Simona Costache
- Titus Alexandru Farcasiu
- Cristian Scheau
- Daniel Octavian Costache
- Constantin Caruntu
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Affiliations: Department of Oral and Maxillofacial Surgery, ‘Carol Davila’ Central Military Emergency University Hospital, Bucharest 010825, Romania, Faculty of Dental Medicine, ‘Titu Maiorescu’ University, Bucharest 031593, Romania, Department of Gastroenterology, ‘Carol Davila’ Central Military Emergency University Hospital, Bucharest 010825, Romania, Department of Removable Prosthodontics, ‘Carol Davila’ University of Medicine and Pharmacy, Bucharest 010209, Romania, Department of Physiology, ‘Carol Davila’ University of Medicine and Pharmacy, Bucharest 050474, Romania, Department of Dermatology, ‘Carol Davila’ Central Military Emergency Hospital, Bucharest 010825, Romania
Published online on: April 1, 2022 https://doi.org/10.3892/etm.2022.11291
Article Number: 364
Copyright: © Caruntu et al. This is an open access article distributed under the terms of Creative Commons Attribution License.

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Abstract

Since the COVID‑19 pandemic outbreak, the medical systems were challenged by continuously increasing numbers of infections and faced critical issues when trying to find solutions for patients suffering from other diseases, including patients with head and neck cancers. Complex surgeries were delayed due to an acute deficit of specialized intensive care medical staff and equipment, which were redirected towards COVID‑19 hospitalized cases, with irreversible consequences for the patients. In the present study, the case of locally advanced head and neck cancer was presented, which was treated radically during the heaviest wave of the COVID‑19 pandemic in Romania using an alternative approach for immediate defect reconstruction. The case of locally advanced buccal carcinoma (staged T4aN0Mx) was reported, where radical tumor excision was followed by immediate reconstruction using a combination of two regional flaps, temporal and submental, in order to provide timely and optimal medical care. In the difficult context of the COVID‑19 pandemic, the standard reconstructive technique, which is the free vascularized tissue transfer, could not be performed for this patient, due to the acute deficit of anesthetists and associated medical staff, as well as the lack of free beds in intensive care units. Combinations of local and regional flaps, such as temporal muscle flap and submental flap, are simple and accessible surgical techniques that require reduced surgical time, minimal equipment, and basic surgical training, advantages that become crucial in historically challenging times, such as a global pandemic. Individual cases, like elderly patients or patients with severe comorbidities, should be considered for these types of reconstructive techniques: simple solutions, single or in combination, which may be an improved therapeutic option for these patients.

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