Introduction: Rhabdomyosarcoma (RMS) of the head and neck is characterized by skull base involvement and a propensity for recurrence. Fortunately, with modern chemoradiation protocols, children enjoy a 70% 5-year survival without radical surgery. However, microsurgical reconstruction may be needed at some point in the care of RMS patients, particularly in those with recurrent tumors requiring radical resection and in those suffering long-term consequences of prior radiotherapy.

Purpose: To critically evaluate a series of RMS patients in order to define the role of the reconstructive plastic surgeon.

Methods: Our prospective database revealed 17 patients with RMS of the head and neck seen in the plastic surgery clinic at MD Anderson Cancer Center from 1990 to the 2002. Charts were reviewed for demographic information, prior therapy, extent of surgical resection, type of flap(s) used, flap complications, number of recurrences, and overall survival.

Results: Thirteen of the 17 patients were reconstructed after radical resection for extensive primary or recurrent RMS. The mean age at diagnosis was 14.6 yrs (range 2.5-50 yrs). Eight patients had had at least one previous recurrence. The mean radiation dose administered prior to reconstructive surgery was 58 Gy. Five patients had skull base resections. A total of 19 flaps were used in these 13 patients, including 11 free rectus abdominis myocutaneous flaps, two free radial forearm flaps, one free latissimus dorsi myocutaneous flap, one free fibula osseous flap, two pedicled temporalis muscle flaps and two pedicled temporoparietal fascia flaps. Two flaps failed secondary to venous thrombosis, with an overall flap survival rate of 89%. Three patients developed a least one post-reconstructive local recurrence. Six patients are alive at a mean of 3.4 years following reconstruction (range 0.1-10.3 years).

Four of the 17 patients were evaluated for consequences of prior radiotherapy, including radiation-associated sarcoma(1), mandibular osteoradionecrosis (1) and facial deformity (2). One patient had a skull base resection. A total of two flaps were used in these four patients, including one free rectus abdominis myocutaneous flap and one free scapular flap. Two patients await surgery for functional and cosmetic correction.

Conclusion: The microsurgeon’s role in the treatment of patients with head and neck RMS is challenging as it commonly involves skull base reconstruction in previously irradiated patients. Furthermore, these patients are typically young, are troubled with cosmetic and functional sequellae of childhood irradiation, and are prone to recurrences requiring future resection and multiple flap reconstructions.