Siavash Siv Eftekhari, M.D., DMD


Microvascular Free Flap Surgery for Head & Neck Reconstruction

Microvascular Free Flap Surgery for Head & Neck Reconstruction

Microvascular head and neck reconstructive surgery is a medical technique for rebuilding the neck and facial tissues of the body. Skin, blood vessels, and other bodily tissues are extracted from other areas of the body and transplanted to the face or neck to replace lost or excised tissue.

Free flap extraction is necessary for surgical head and neck reconstructions. With a success rate of over 95 percent, free flap surgery recovery and procedure processes are among the safest reconstructive surgical operations. Wherever there is an ample supply of blood, a free flap can be extracted and relocated to any other part of the body. However, the fibula and the upper leg are the most common donor sites for free flap tissues.

Are you wondering, “what is free flap surgery?”

If so, read on. In this article, we will discuss the details of free flap surgery microvascular and how free flap reconstruction for oral cancers work. We will also explore the various methods and techniques with which you can take care of yourself following your surgery.

What Is Free Flap Surgery?

We’re often asked, “what is free flap surgery?”

Whenever surgery is required to remove a tumor from one’s body, free flap surgery fills the space that was the tumor once occupied. Microvascular surgical methods attach the small blood vessels and capillaries from the donor tissue to the host site to ensure normal blood circulation.

After the tumor or malignant mass is extracted from the face or neck region, the void space must be filled by tissues lifted from elsewhere on the body. A reconstructive surgeon is tasked with extracted live tissue from a donor site and reattaching it to the recipient site where the tumor once existed.

Free flap surgery microvascular is a highly complex and rigorous surgery that often requires a skin graft.

Despite their complexity, free flap surgeries are among the safest and most effective head, face, and neck surgeries.

What To Do Before Your Surgery

If you are due for a free flap surgery microvascular, there are steps you should take to ensure that the process is as simple and stress-free as possible.

First, you must meet with your primary surgeon, who will guide you through the initiation stage of the process.

At this point, you will likely schedule a consultation with your reconstructive surgeon who will do one of the following:

  • Schedule a medical clearance appointment to help plan long-term care and minimize risks
  • Schedule a pulmonary or respiratory exam
  • Schedule an angiogram (blood vessel test) in the legs
  • Book a CT, MRI, or x-ray on areas of interest in the body

Pre-surgical testing (PST) is an important phase of the surgical procedure. At this stage, you will eat and take your prescribed medications as normal and will meet with a nurse practitioner to review your medical history.

Your nurse practitioner will help determine the extent of the medical exams you must undertake before receiving surgery and will inform you about dietary and medication protocols prior to your surgery date.

Your first PST appointment is an important stage of your pre-surgery journey. To save yourself time and unnecessary stress, we advise bringing along the following documents:

  • A document listing all your prescribed medications
  • A document listing all your health test results
  • Contact information of your current primary healthcare providers

What Is Microvascular Reconstructive Surgery?

If you’re still asking yourself, “what is microvascular reconstructive surgery,” then you can think of the procedure as borrowing tissue from another part of the body and shaping into the body part that you need. Bone or skin tissue is often extracted from the leg and relocated to the head or neck region to replicate the natural tissues that were once there.

Your doctor may have discovered the presence of a tumor after screening for neck masses and lumps.

Once detected, malignant tumors of the neck or face are extracted as quickly as possible and the affected area must be reconstructed for cosmetic and functional purposes.

Imagine oral cancer that spreads to the mandible bone, otherwise known as a jawbone. In this case, a portion of the mandible bone must be removed from the patient. Without a complete jawbone, the patient will experience extreme difficulty speaking and chewing and will suffer from cosmetic deformations.

To reconstruct their jawbone, the patient must have a portion of their fibula (secondary shin bone) extracted and formed to their mandible. This way, normal function, and appearance can be restored to the patient’s facial region without disrupting their quality of life.

Why Is The Fibula Extracted?

Bony holes in the body are often filled by a fibular free flap and inserted into the jaw. Fibular free flaps are the most popular types of flaps in head and neck surgery. Usually, fibular flaps replace bone tissue loss due to oral cancer surgeries.

The fibula is a long, thin bone found inside the lower leg, running parallel to the larger tibia. The fibula stabilizes the ankle and the surrounding tissue, whereas the tibia supports the structural integrity of the entire leg. Since the fibula is secondary to the tibia, the former provides a suitable base of bone tissue from which to extract for free flap operations.

Unless you are a professional athlete, you do not need your whole fibula intact.

You can safely walk, hike, swim, job, and ride a bicycle with a portion of your fibula removed. Therefore, most non-athletes have fibular tissue harvested and grafted onto the mandible bone after suffering hard tissue loss to cancer surgery.

Following a fibular tissue extraction, your shin will have a scar that will gradually fade. Often, the scar runs along the exterior of the leg from below the knee joint to just above the ankle. Your leg will require a bandage for approximately a week post-surgery, and over-the-counter painkillers are typically prescribed to help manage the acute pain following the operation.

What Is The Difference Between a Skin Graft and a Flap?

Usually, when we discuss free flaps, our patients ask us: what is the difference between a skin graft and a flap?

The main difference between a skin graft and a free flap is that a skin graft is nothing more than a piece of skin. Grafts do not involve a blood supply and are therefore faster and simpler surgical operations.

On the other hand, flaps are extracted and grafted with an intact blood supply. In some cases, grafts are taken and transferred with muscle attached. Whether with the muscle intact or not, grafts are more demanding surgical procedures that require microvascular procedures to attach blood vessels to a blood supply at the recipient site.

Regardless of whether you receive a free flap or graft, your medical team will apply local anesthesia to help manage or eliminate pain during surgery. You will be allowed to leave the hospital and return home later that day. However, regional and distant flaps are extracted under general anesthesia, which may require a longer visit to the hospital.

Ultimately, it is the decision of your surgeon how long you must stay under their care before returning home.

Types of Flaps

When you receive head or neck reconstructive surgery, you will likely receive a flap.

However, there are several varieties of flaps that you might receive. We’ve listed each of the main flap types below.

Distant Flaps

Distant flaps are extracted from a region of the body that is opposite to the recipient site.

For instance, a mandible surgery might receive a distant flap from the fibula, which is located all the way in the shin.

There are two types of distant flaps that are extracted for surgical purposes, including:

  • Pedicled Flaps: These flaps are used to reconstruct another region of the body, but they are still attached to the blood supply of the donor site (e.g., a pedicled flap from one’s breast used to reconstruct their shoulder).
  • Free Flaps: These flaps are totally detached from their original site and blood flow supply. Free flaps are attached to a new blood supply at the recipient site.

Regional Flaps

Regional flaps are taken and grafted onto a part of the body that is in the same general area.

For instance, a regional flap from the lower chest may be used to reconstruct a part of an individual’s upper torso.

Local Flaps

Local flaps are extracted from a site immediately adjacent to the recipient site.

Often, local flaps are taken from a cosmetically unimportant area of one’s body (e.g., under the chin) and used to reconstruct a more sensitive area such as one’s cheek.

Testing For Oral Cancers

Early detection of oral cancers affecting the head, mouth, and neck region can prevent microvascular free flap surgery. To detect oral cancers before they require free flaps or grafting, you must know how to screen for oral cancers while at home.

The earlier you detect something unusual, the more likely you will keep your original tissue without needing a flap.

Performing Self-Exams

The best method for performing a self-exam for oral cancer begins with finding a flashlight, washing your hands, and looking into a mirror. Once you’re ready, you can complete the oral cancer self-exam by following these steps:

  • Scan your face for cosmetic irregularities of any kind
  • Examine the inside of your lips for textural changes
  • Feel your gums and shine a light on the insides of your cheeks for any bleeding or visual differences
  • Check out your tongue and notice if there are any firm lumps on its surface
  • Use two fingers to press around your neck for any bumps
  • Use the same two fingers to press on and around your Adam’s Apple
  • Swallow and notice whether your Adam’s Apple easily bobs up and down (if it doesn’t, you may have a growth obstructing its movement)

Preventative cancer screening is crucial if you want to maximize longevity.

For the best results, it is recommended that you perform the checklist above every month. However, most dentists also perform the same checks, so you may not have to conduct a self-examination during the months that you visit your dental clinic.

Signs & Symptoms of Oral, Head, and Neck Cancers

To protect yourself against oral cancers and prevent undergoing microvascular surgeries, you must become familiar with their signs and symptoms. Most cancers of the head and neck are identifiable by the following early warning signs:

  • Ulceration of the oral region that won’t heal
  • A lingering sore throat that lasts multiple days
  • Numbness in the face or jaw
  • Sudden vocal changes and inconsistencies
  • Difficulty chewing and eating food

If you exhibit any combination of the above symptoms, you should first perform a thorough oral cancer self-examination. After your examination, consult your primary healthcare provider about your symptoms and whether you might require a professional exam.

Oncologists and radiation oncologists are doctors who specialize in cancer screening, and who will likely perform more rigorous testing in a hospital environment. Should your doctors decide to conduct a full cancer screening, they may prescribe any of the following advanced tests:

  • CT scan imaging on lymph nodes
  • MRI scans to examine tumor size
  • Blood tests to determine your overall health
  • Panendoscopy to view inside the mouth and oral region
  • Physical, in-clinic head and neck exam

Although self-exams are important for discovering the early warning signs of oral, head, and neck cancers, only the medical exams listed above can precisely detect the presence of tumors.

Once diagnosed, your healthcare provider will discuss treatment options with you and work toward an optimal medical solution.

Weighing Your Treatment Options

When it comes to receiving the best healthcare possible, you should trust the experts with a proven track record of surgical success for microvascular free flap patients.

For the best care in the Dallas-Ft. Worth (DFW) metro area, contact Dr. Efekhari and the Next Generation OMS surgeons today and see why they’re the leaders in free flap reconstruction for oral cancer.