Head and neck reconstruction is typically required following trauma or injury to the face through cancer, accident or congenital deformity.
In addition to basic head and neck reconstruction techniques using grafts and local skin flaps, Dr Sharp also performs microvascular head and neck reconstruction; a technique for rebuilding the face and neck using blood vessels, bone and tissue, including muscle and skin from other parts of the body.
The technique is one of the most advanced surgical options available for rehabilitating surgical defects that are caused by the removal of head and neck tumors.
It involves harvesting flaps of healthy tissue with its blood supply (vessels) still attached, from other sites in the body. Watch Dr Sharp perform microvascular surgery in the video, right.
The tissue is then transferred to the recipient wound bed, where it is much more useful in reconstructing the affected area of the head and neck.
A microscope is used to suture the blood vessels of the flap to blood vessels in the neck, allowing the tissue to live as if it were back in its original location.
Most of the skin cancers that require reconstructive surgery using flaps involve squamous cell carcinoma (SCC) or melanoma, sometimes due to a local invasion of nerves and bone.
Tumours are graded according to the size and location of the primary tumour and the presence of local disease spread (most commonly in the neck). Tumours that spread to the neck are still curable but often require more aggressive treatment.
Primary treatment options for head and neck cancer include surgery, radiation, or both. Chemotherapy is sometimes used as an additional treatment option. The appropriate treatment for you depends on the tumour size, location, past treatments, and patient preference. The treatment plan is developed in discussion with your head and oncology team. Treatment may require a reconstruction to improve post-treatment cosmetics, swallowing or speaking. While the reconstructive procedure is often a necessary part of the tumour removal, it is important to understand the risks and benefits associated with the reconstructive procedure.
Flap loss may result if a blockage occurs at the point of arterial or venous attachment to the flap. A blockage may require return to the operating room in an emergent fashion to try to remove the blockage. Wound disruption or delayed wound healing is possible. It is possible to have areas of the flap die. This may require frequent dressing changes or further surgery to remove the non-living tissue.
Individuals who have decreased blood supply to tissue from past surgery or radiation therapy may be at increased risk for delayed wound healing and poor surgical outcome. Patients who are heavy, overweight, or obese with a high BMI may have a higher risk of delayed healing and flap loss. Smokers have a greater risk of skin loss and wound healing complications.
All surgery leaves scars, some more visible than others. Although good wound healing after a surgical procedure is expected, abnormal scars may occur within the skin and deeper tissues. Scars may be unattractive and of different colour than the surrounding skin tone.
While serious complication are rare, as with all surgery, they do occur from time to time; it’s important to consider the potential impact on your financial, physical or mental wellbeing.
A traumatic injury or diagnosis of cancer are difficult challenges for patients and their families to face, and its normal for the prospect of reconstructive surgery to feel overwhelming and confusing. Our team is here to help you navigate your reconstructive journey.