Offering Immediate Restoration of Form and Function
The Department's Division of Otolaryngology–Head and Neck Surgery has a state-of-the-art clinical program in microvascular free-tissue transfer for head and neck reconstructive surgery. This program, which offers patients considerable benefits over conventional reconstructive surgery, is made possible by the surgical expertise of Maisie L. Shindo, MD.
A nationally renowned specialist in head and neck reconstruction, Dr. Shindo joined our faculty in February 1997 as associate professor of surgery (otolaryngology–head and neck surgery) and director of head and neck oncology. She is specially trained in performing the latest techniques of microvascular free-tissue transfer in head and neck reconstruction following surgery for cancer.
Dr. Shindo explains, "The goals in the surgical treatment of head and neck cancer
are first to completely remove the tumor, and second to restore function and esthetics in a
single-stage operation. While these goals were difficult to achieve a decade ago, it is now
possible and is the new standard of care with the techniques of microvascular free-tissue
Clinical studies show that primary reconstruction (performed at the same time as ablative surgery) is generally superior to delayed secondary reconstruction, because function is restored earlier, and less scarring and contracture occur.
The potential for restoration of sensation is an exciting new area in head and neck reconstruction, about which Dr. Shindo says, "In the past, removed tissue, such as tongue and pharynx, were replaced with adynamic, insensate tissue. We now have the capability to restore sensation to those sites by anastomosing appropriate sensory nerves."
What It Is
Defects in the head and neck resulting from the surgical removal of malignant tumors frequently lead to disabling functional and cosmetic deformities. In the past, extensive surgical therapy of this kind was restricted by the patient's inability to tolerate the resultant deformity and functional disability, such as speech and swallowing.
Now, with the advance of microvascular free-tissue transfer which took place in the mid-1980s, the approach to head and neck reconstruction has been revolutionized.
Microvascular free-tissue transfer is the technique of transferring the patient's own healthy tissue, such as bone and skin, together with its blood supply, and ensuring viability by anastomosing the vessels of the transferred tissue to blood vessels in the head and neck.
As revascularized segments of tissue, these free flaps are highly advantageous in the
management of head and neck cancer because they can withstand radiotherapy, which many
patients require postoperatively. In addition, they are preferable to other methods of
reconstruction in patients who have undergone radiotherapy because these flaps have an
especially reliable blood supply.
Prior to the use of free-tissue transfer in head and neck reconstruction, large complex defects were routinely reconstructed with pedicled flaps, usually the pectoralis muscle and overlying chest skin.
There are several disadvantages and limitations of this old technique: 1) only a limited amount of soft tissue is available from the chest; 2) vascularized, healthy bone is not available for mandible reconstruction; and 3) the patient is left with an unsightly defect (distorted ripple) at the donor site.
Microvascular free-tissue transfer offers the ability to three-dimensionally reconstruct a complex head and neck defect, such as one resulting from removal of jaw, tongue, floor of mouth, and soft palate. In such situations, a flap comprising appropriate tissue components (bone, skin, muscle) from the groin can be transferred to "custom fit" the head and neck defect.
The wide variety of potential donor sites in the body allows the reconstructive surgeon to accomplish this improved care in head and neck reconstruction. The selection of donor tissue is determined by the specific goals of the surgery, as different parts of the body offer different advantages.
Today, the absolute indications for performing microvascular free-tissue transfer are for the reconstruction of anterior mandibular and floor-of-mouth defects, circumferential pharyngeal defects, and extensive soft-tissue and bony defects of the face. It can also be considered in many other situations as an alternative to the use of a regional flap.
Recent studies have shown that, compared to pedicled flap reconstruction, free flap reconstruction in the head and neck region yields superior functional and esthetic results, a lower wound complication rate, and less donor-site morbidity/deformity.
It should be noted that special fellowship training, which Dr. Shindo completed with distinction, is required of surgeons who perform head and neck reconstructive surgery using microvascular techniques. Moreover, as a member of the full-time faculty at the University of Southern California, Dr. Shindo taught residents and fellows these new techniques.
Dr. Shindo received her MD from the University of Southern California in 1984. She completed her residency training in otolaryngology–head and neck surgery at the University of Southern California-Los Angeles County Medical Center, and earned her board certification in 1989.
Subsequently, she pursued fellowship training in head and neck oncology and in head and neck microvascular reconstructive surgery at Northwestern University Hospital and Ohio State University, respectively.
In 1991, she joined the faculty of the Department of Otolaryngology–Head and Neck Surgery at the University of Southern California, where she gained national recognition for her work in microvascular head and neck reconstruction.
Dr. Shindo's special clinical/research interests in oncology include the management of thyroid cancer and the reconstruction of head and neck defects following cancer resection.
She also has expertise in other specialized areas of otolaryngology–head and neck surgery, including surgery for paralyzed vocal cord and facial paralysis.
An active author as well as a busy clinician, Dr. Shindo has published numerous articles and book chapters on a range of clinical topics in her field, in addition to original research reports.
She currently serves on the editorial review board of Otolaryngology–Head and Neck Surgery, Laryngoscope, Head and Neck, Archives of Otolaryngology–Head and Neck Surgery (co-editor, Facial Plastics News Section), and The Otolaryngology Journal Club Journal.