The aim of the oncology surgeon is to remove the tumour with a margin of healthy tissue. This will however result in a defect that needs to be covered by replacing the lost tissue through reconstructive surgery. Reconstructive surgery is a necessary part of cancer surgery for various reasons. Depending on the location and size of the defect, these include sealing off the oral or nasal cavities; restoring the continuity of the gullet; restoring functions such as chewing, swallowing and speech; protect critical structures like blood vessels and nerves from saliva and bacteria; and improving the aesthetic appearance after surgery.
Reconstruction is performed by "borrowing" tissue from other parts of the body to cover the defect. Such a tissue is called a flap, which must be harvested together with its delicate blood vessels to ensure it will continue to have blood circulation and can thus survive.
Flaps harvested near the site of the defect can be rotated or pulled to where it is needed. Often, however, more suitable flaps are harvested far away from the head and neck region. In such instances, the blood vessels have to be cut to allow the flap (now called a free flap) to be brought over to the defect. The flap vessels are then connected to other blood vessels in the vicinity to restore blood flow to the flap, through a process called microsurgery, using a microscope and extremely fine sutures to stitch the tiny blood vessels together.
The reconstructive surgery will be performed concurrently with the surgery to remove the tumour while you are under general anaesthesia.
Some commonly used flaps in head and neck reconstruction include the following:Pectoralis Major flap (chest)
Latissimus Dorsi flap (back) Anterolateral Thigh Flap (outer thigh) Radial Forearm flap (forearm)
Fibula flap (calf)
The locations where the flaps are harvested from usually heal well with proper wound care. There may be temporary side effects after surgery, such as stiffness, weakness or numbness, but these usually improve well with rehabilitation from our physiotherapy colleagues. There are typically no major long term side effects; once fully recovered, your daily activities and your ability to exercise should not be affected.
Besides bleeding, infection, and scarring that can occur in any surgery, reconstructive surgery has specific risks involved. These include:Flap failure The blood circulation to the flap may be poor resulting in part or all of the flap tissue not surviving. This risk is highest in the 1st 1-3 days after surgery. Emergency surgery may be needed to salvage the flap. If the flap cannot be saved, it will unfortunately have to be discarded, and a 2nd flap surgery will be needed to reconstruct the defect, as the defect cannot be left uncovered.Infection / salivary leak Due to their location in the aerodigestive tract, the wounds from the surgery are often in contact with saliva and bacteria. Saliva may seep through the stitched wounds causing deep infection in the jaw or neck. This tend to occur starting from day 3 to 5 after surgery. Repeat surgeries may be needed to control and eventually clear the infection.Poor wound healing The exposure of the wounds to an environment of saliva and bacteria may result in poor wound healing, wound breakdown and subsequent infection. Mild cases may be just treated with dressings while they heal, but severe cases may require repeat surgeries or even a 2nd flap surgery to plug the area of breakdown.Immobility Being immobile for a period of time after surgery increases risk of chest or urine tract infections, as well as blood clot formation in the legs and lungs. The aim is to reduce these risks by getting you to mobilise and walk as soon as it is safe to do so.
