Reconstruction following tumour removal

Head and neck cancer can require extensive and sometimes dysfiguring surgery.  Even when the outside of the face is not effected, the loss of parts of the tongue, palate or throat can impact on function and quality of life to a great degree.

Where possible and practical, the reconstruction of the organ being treated can help overcome some of the debilitating effects of cancer surgery in the head and neck.  Some of the ways in which reconstruction can be achieved include the following

Local flaps - for smaller surgical defects, local tissue can be use to fill or cover an area or volume.  Examples include a rhomboid flap on the face or a FAMM flap for a defect inside the mouth.

Healing rhomboid flap

 

Regional flaps - where a larger defect exists, a regional flap can be used to move a large area of tissue in to fill or cover.  This is a very reliable means of tissue coverage and requires shorter operating time and less specialised equipment than free tissue transfer.  Examples include the pectoralis major myo/myocutaneous flap and the trapezius flap.

Pectoralis major skin designTrapezius flap

Pectoralis flap design and Trapezius flap deisgn

 

Free flaps (free tissue transfer) - where appropriate, a part of the body that has similar components (eg bone, skin, muscle) that is remote from the defect can be harvested and moved to the defect.  This involves bringing with the tissue its nourishing blood vessels, so that these same blood vessels can be reattached to vessels in the neck to bring the free flap back to life.  Microsurgery is used to reattach these blood vessels.  This form of reconstruction involves a longer operation than a regional flap, but can often give a more tailored reconstruction with greater flexibility.  For this reason, in Australia, it is widely used for head and neck reconstruction with a high degree of success.  A failure rate of less than 3% should be anticipated, with about 5% of free flaps needing surgical correction of blood flow insufficiency in the days following the microsurgery. 

 

Radial forearm fasciocutaneous free flap

 
Fibula osteocutaneous free flap