Learn more about Reconstructive Surgery and other symptoms,
and how it can be treated here at NC TAN Surgery.
What is Reconstructive Surgery?
Operative treatment of head and neck cancers can result in impairment of major bodily functions such as swallowing, speech, respiration, and appearance. Alongside control of the disease, rehabilitation is an essential goal of treatment. This applies to skin cancer as well, especially if they are located at the face.
Reconstructive surgery, often in the form of flap surgery, aims to restore form and function for rehabilitation.
Flap surgery refers to the transfer of tissue, with its blood supply, from a healthy part of the body (donor site) to the defect (recipient site).
Flaps can be categorised into local, regional and free flaps.
Local flaps are harvested from tissue right next to the defect.
Local flaps are commonly performed in the head and neck area due to their excellent colour and texture match. They are frequently used for closure after resection of skin cancers.
An example of a local flap is the rhomboid flap.
Rhomboid flaps are transposition flaps that are rotated about a pivot point. They are designed with 60- and 120- degree angles, and the longitudinal axis of the rhomboid parallels the line of minimal skin tension. This technique can be expanded to create a double or triple rhomboid flap for large skin defects. The donor site of the flap can usually be closed by direct sutures.
When there is inadequate tissue right next to the defect for coverage, regional flaps are harvested from tissue in the vicinity of the defect. Regional flaps are raised based on a specific vascular system. The flap is rotated into the recipient site with its pedicle attached at its base.
Donor sites can be closed by direct sutures or skin grafts.
Examples of regional flaps commonly used in the head and neck include the pectoralis major flap and latissimus dorsi flap, which are pedicled flaps usually harvested as a myocutaneous flap consisting of both muscle and skin.
In addition to reconstructing large defects, these flaps serve to protect the great vessels after neck dissection, especially against the effects of radiation therapy.
Microsurgical Free Flaps
The arrival of microsurgical techniques which uses special operating microscopes and instruments, has allowed the possibility of performing intricate operations on tiny blood vessels in our body. This, in turn, has made tissue transfer from a distant site to reconstruct defects in the head and neck region after surgical resection feasible.
The tissue that is harvested from the patient’s own distant body site for reconstruction is known as a free flap. This includes the skin and often with its surrounding tissue, together with its supplying blood vessels. This free flap is then detached from its donor site and transplanted to the head and neck area where the blood vessels are reconnected under microscopic magnification, and the skin is used to resurface the defect.
Microsurgical reconstruction has allowed surgeons to adopt a more aggressive approach in resecting tumours that would have resulted in defects that were previously deemed too extensive for reconstruction.