Major Facial Reconstruction
Microvascular free tissue transfers, also known as free flaps, are the highly skilled technique where tissue (bone, muscle, fascia, fat and/or skin) is taken from one area of the body and transplanted to reconstruct a different area. This requires a microvascular connection of the artery and vein in the transplanted tissue to the new site to provide a blood supply to the transplanted tissue. Free flaps are used to restore appearance and function, most commonly after removal of large head and neck cancers. Our goal is to provide a reconstruction that allows you to return to optimal functioning and restore a high quality of life.
For major facial reconstruction due to extensive head and neck cancers, this usually involves a team approach where the cancer removal is very involved and typically performed by our partners in head and neck oncologic surgery, with the facial plastic and reconstructive surgeon performing the reconstruction. In these cases there is usually not enough neighboring tissue once the cancer defect is removed to perform an adequate reconstruction and additional tissue must be transplanted from a distant part of the body by a free flap. It can be used to replace missing skin on the face/scalp as well as internal areas such as the cheek lining, throat, or even the jaw. A free flap procedure involves removing the required tissue (skin, muscle, fascia and/or bone) from a distant body site like the arm, leg, or back. The tissue is then transferred along with its artery and vein and transplanted into the new site using a microscopic connection to an artery and vein in the neck; this provides a nourishing blood supply and life to the transplanted tissue. This technique is complex and requires specialized training but is an excellent way to repair large cancer defects that could not be repaired by other methods. This type of reconstruction has an excellent success rate of 90% to 95% for most patients.
- Scapula/Latissimus (Back)
- Radial forearm/ Ulnar forearm (Arm)
- Fibula (Lower leg)
- Anterolateral thigh (Upper leg)
- Rectus Abdominis (Stomach region)
- Orbit (eye)
- Temporal bone/Ear
- Oral (mouth/jaw)
- Larynx (voice box)
- Sinus/Skull base
This is a complicated procedure and does require a stay in the hospital. This usually includes a short stay in the intensive care unit (ICU) followed by several days in our post-surgical unit. Throughout your hospitalization we will be very carefully monitoring the blood flow to the transplanted tissue. During your stay many different caregivers will be involved in your recovery such as speech and swallowing therapists, physical therapists, and respiratory therapists. Depending on the area reconstructed you may need a feeding tube to maintain intake of calories while you are healing, or a tracheostomy to ensure safe breathing.
These flaps move tissue from adjacent areas to the head and neck and bring along with them their blood supply as a "pedicle." This does not require the surgeon to create a new connection of blood vessels for the tissue to live as the tissue maintains its original blood source. Options for this type of flap may include the pectoralis major, supraclavicular, trapezius, or latissimus (chest and back region). These flaps are often use with patients who have undergone previous extensive surgery in the area that limits the availability of blood vessels that would be needed for a free flap.