When a tumour of the mouth, throat, jaw or neck is removed, the tissue that is lost has to be replaced so that the person can swallow, speak and breathe, and so that the face keeps its shape. Microvascular reconstruction (free flap surgery) does this with living tissue taken from another part of the patient’s own body, moved to the head and neck, and reconnected to a blood supply there under a microscope.
What it is
A free flap is a piece of skin, fat, muscle or bone taken together with the artery and vein that feed it. It is shaped to fit the defect and placed in the head and neck, and its vessels are joined to vessels in the neck with stitches finer than a hair, under an operating microscope, so that blood flows through it again. The reconstruction is normally done in the same operation as the tumour removal. Typical flaps come from the forearm for the lining of the mouth and throat, from the thigh for larger defects, and from the fibula when part of the jaw has to be rebuilt with bone.
Who it is for
Adults undergoing removal of a large cancer of the tongue, floor of the mouth, jaw, throat or skin of the head and neck; people with a defect or a wound that will not heal after earlier surgery or radiotherapy; and, in selected cases, people who need the airway or gullet rebuilt.
Symptoms and diagnosis
Reconstruction is planned as part of the treatment of the tumour. Imaging of the tumour shows what must be removed; imaging or ultrasound of the arm or leg may be used to check the vessels of the donor site; and the person’s general health, circulation and smoking are assessed, because they affect healing.
How the operation is done
The operation is performed under general anaesthesia and takes several hours. While the tumour is removed, the flap is raised from the donor site with its vessels. It is then placed in the defect and shaped, and the vessels are joined under the microscope. The neck incision and the donor site are closed, and a temporary tracheostomy and a feeding tube are used while swelling settles. In the days after surgery the colour, warmth and blood flow of the flap are checked frequently, so that any problem with the vessels is found and corrected at once.
Recovery
The first days are spent in hospital under close observation. Feeding starts through the tube and moves to the mouth as healing allows; swallowing and speech therapy begin early. Most people leave hospital within one to two weeks. The donor site heals over a few weeks, and the flap softens and settles over months. Further treatment such as radiotherapy, when needed, is timed to allow healing.
How Prof. Hafız works
Microvascular head and neck reconstruction is one of the focus areas of Prof. Hafız’s practice, and his published research includes studies on free flaps from the forearm and the fibula for the reconstruction of the mouth and jaw. He spent a research fellowship at the Head and Neck Institute of the University of Wisconsin–Madison in 1993. The plan for the reconstruction, the donor site and the expected course of recovery are discussed with you before the operation.