Head and Neck Reconstructive Surgery
Often times clearing all cancer from the head and neck requires removing tissue from the face, mouth, throat, or neck that could have a major impact on form and function. Therefore, any surgeon treating head and neck cancers must have the ability to reconstruct any size defect.
There are two types of flaps used in head and neck reconstruction: regional and free flap. A regional flap is using nearby tissue that is pedicled off of an artery and rearranging it to fill or cover a defect.
Free flaps are used for larger volume defects or if healthy tissue is required to heal in a field that has previously been radiated. Bone and/or soft tissue is transplanted from the arm, thigh, leg, or back and hooking up the respective blood vessels to the neck.
The most common regional flaps used in head and neck reconstruction are the pectoralis muscle flap, submental flap, and supraclavicular flap.
- Pectoralis muscle flap – using muscle off the chest wall and bringing it up to the neck and covering defects of the throat and neck.
- Submental flap – using skin, fat, and muscle from the undersurface of the chin to rebuild a tongue, floor of mouth, or side of the face.
- Supraclavicular flap – this flap borrows skin and fat from the shoulder to cover the side of the head, central neck, and areas in the mouth.
- Radial forearm free flap – the most commonly used free flap in head and neck reconstruction. It is a thin and pliable flap that involves harvesting skin and fat from the forearm with its blood vessels and closing any soft tissue defect. It can be used to replace facial, scalp or neck skin, reconstruct the mouth / tongue, throat, and serve as a barrier between saliva and the neck.
- Anterolateral Thigh flap – this is also a soft tissue flap, but used for larger volume defects of the tongue, throat or face. It has more volume because the thigh has more fat and muscle may be included with the flap.
- Fibula free flap – this flap is harvested from the lower leg and is used when bone is required for reconstruction. The most common use is to reconstruct the mandible, or jaw bone. One of its advantages is that dental implants may be used, which improves functional results (chewing) and the cosmetics.
Benefits of advanced reconstruction
- Early return to normal function, particularly, speech and swallow.
- Improve cosmetic outcomes.
- Reduce healing time and wound break down in patient’s that have had prior radiation.
Risks of reconstructive surgery
- Flap failure – it is rare for a regional flap to fail. If it does, it is usually related to an infection or other medical problems like diabetes, poor nutrition, or prior radiation. Free flaps are 95-98% successful. That means 1 in 20 or less will require going back to the operating room to salvage or revise the flap.
- Delayed wound healing – inspite of using healthy tissue for reconstruction, it can take time for wounds to heal and to allow complete separation of nose, mouth, and throat from the neck. This could delay return to normal function.
- Donor site morbidity – the extremities used to harvest tissue take a minimum of 1 week to return to normal use, but can take several weeks to return to normal function.
These are general risks of reconstructive surgery but certainly not exhaustive. Dr. Thakkar will walk you through the surgery in more detail and provide you with more details specific to your resection and reconstruction.
- Regional flap reconstruction allows for less monitoring and possibly earlier discharge, whereas free flaps will have intense monitoring in the ICU for at least 3 days followed by time on a surgical floor.
- Your specific defect can dramatically impact length of stay, but it is not uncommon to remain in the hospital for 7-10 days.
- You will have a complimentary team of medical doctors, nurses, speech and language and pathologists, physical therapists, and occupational therapists that specialize in head and neck cancer patients checking on your during your hospitalizations.
- Functional outcomes are significantly improved when patients have a support system available to them at home. Try and find friends or family that can stay with you in the immediate post-operative period.
- Home health care is arranged prior to discharge for patients that require trained help. They may help 2-3 days a week, but often times this is up to the insurance company.
- Home supplies are arranged by the discharge planner at the hospital.