Considerations for reconstruction after surgery for recurrent cancer.

Refinements in our knowledge of the anatomy and physiology of myocutaneous and fasciocutaneous flaps has served as the impetus to apply these modalities to achieve healed, stable wounds in areas undergoing wide exenterative resection for recurrent rectal carcinoma. The adverse effects on tissue from adjuvant or therapeutic radiation therapy is greatly ameliorated by these healthy nonirradiated tissues, which serve as a conduit for oxygen as well as humeral and cellular factors to enhance the immune response as well as to aid wound healing. Moreover, refinements in surgical technique have allowed the reconstructive surgeon to Radical ablative surgery is possible because of the advances over the past half century in our understanding of cancer, surgical principles, anesthesia, preoperative preparation, and postoperative support. It can be argued that radical ablation without reconstruction promises increased quantity of life, which is only half of the equation. Only quality of existence can make even a few more months of life truly meaningful for a patient. This is the real contribution of reconstruction. It is with the expectation that form and function can be restored toward the premorbid state that the surgical oncologist can confidently recommend radical salvage procedures that provide both quantity and quality of life.