Head and Neck Reconstruction Surgery

Head and neck reconstruction surgery is an advanced surgical option for improving the form and function of the face, jaw, ears, and skull. Head and neck surgeons are often called on to rebuild the face and neck after removing tumors or to correct deformities, treat injuries, and address slow wound healing.

Treating cancer of the head and neck can lead to side effects that can negatively impact function, such as sight, smell, taste, breathing, speaking, and swallowing. Cancer treatments can also negatively impact the appearance of the head and neck region. Head and neck cancer treatments can cause scarring, swelling, and facial amputation, leading to body image distress in as many as 20% of patients.

At the Institute for Advanced Reconstruction, we specialize in some of the most advanced head and neck surgeries in the field, including:

Skin Graft Surgery

Skin graft surgeries remove healthy skin from one area of the body and then transfer it to another where the skin is missing or damaged. There are different types of skin graft procedures, including:

• Partial skin graft: surgeons remove a thin layer of skin
• Full skin graft: surgeons remove all layers of skin
• Composite skin graft: surgeons remove all layers of skin plus fat tissues and underlying cartilage

Flap Surgery

During flap surgery, a surgeon will partially detach a living piece of tissue and transfer it to another part of the body. The flap and blood vessels remain attached to their original location, which allows blood supply to the repaired area to remain uninterrupted. In some cases, your surgeon may perform a "free flap" procedure in which the tissues and blood vessels are disconnected entirely and then moved to another location using microsurgical techniques to reconnect the blood vessels at the new site (also known as microvascular head and neck reconstruction).

Your head and neck surgeon will give you detailed instructions on what to expect from a head and neck reconstruction surgery based on your specific injury and the type of surgical techniques they will use. If your reconstruction surgery is happening concurrently with treatment to remove a tumor, two surgical teams may be involved.

Prior to surgery, your team may conduct additional testing, such as imaging or tumor mapping/biopsy, to fully understand the scope of your condition.

Head and neck reconstruction surgery is done under general anesthesia. Depending on your specific treatment plan, the surgical procedure could take 8 to 12 hours to complete. Tissues such as skin, muscle, fat, and bone may be harvested from another area of your body and then attached to the affected area of your head or neck. A drain may be placed in the surgical site. If your surgeon believes it is unsafe for you to eat by mouth immediately following your surgery, they may insert a feeding tube. 

After your surgery, you will remain in the hospital for a few days for observation. During your hospital stay, nurses or physical therapists will encourage light activity to help improve lung, bowel, and circulatory function.

After you've been discharged from the hospital, you may need some help at home. If you do not have a family member or friend who can act as a caregiver, you may require a home health aid. This is particularly important if you've been discharged with feeding tubes. Your surgical team will provide detailed instructions on how to care for your dressings at home and ways to keep your wounds clean and dry.

It is common to have numbness in the affected area following a procedure, as well as a feeling of exhaustion for a week or two after you've been sent home. After about a week, you will return for a follow-up visit. Your surgeons will give you a detailed plan for removing drains and feeding tubes and starting physical therapy, which may include speech or swallow therapy. 

As with all surgical procedures, certain risks and side effects are possible. Because many head and neck reconstructions are the result of cancer treatments, these patients may be at an even greater risk of complications. Factors such as existing comorbidities (cancer), malnutrition, smoking, advanced disease, and previous chemoradiotherapy can all increase the risks of surgery. In addition, risks may include:

• Flap failure
• More surgery required
• Anesthesia-related complications
• Slow wound healing
• Bleeding
• Infections

Candidates for head and neck reconstructive surgery may include individuals who have experienced facial fractures, cancer of the head or neck, or other conditions that have caused damage to the head or neck. The suitability of head and neck reconstructive surgery will depend on the specific needs and goals of the individual, as well as the availability of suitable techniques and resources. Your current cancer treatment plan may also factor in. Generally speaking, an ideal surgical candidate is:

• Under the age of 65
• Healthy weight
• Non-smoker
• Healthy diet/ lifestyle
• No comorbidities (diabetes, high blood pressure, untreated cancer)

Schedule an appointment today with one of our head and neck surgeons to learn more about the possibilities we offer with advanced reconstructive surgery.