Patient education: Reconstruction after surgery for head and neck cancer (The Basics)

What is head and neck cancer? — 

Head and neck cancer, or "HNC," is a group of cancers that form in the head and neck area (figure 1).

There are different ways to treat HNC, including surgery. For example, surgery can be done to remove part of the tongue, jaw, face, or throat. The goal is to remove as much of the cancer as possible without having a negative effect on your quality of life.

What is reconstruction? — 

This means closing the wound after surgery. In some cases, it is simple. But sometimes, cancer surgery changes the way a person looks or makes it hard to eat, swallow, and talk. When this happens, surgeons might need to rebuild a body part.

Your doctor will talk to you about your situation and what type of reconstruction you need. Whether it is necessary to rebuild the part that was completely or partly removed depends on a few different things. These include the size and location of the cancer, how far it has spread, and what other treatments you have had.

If only a small area was removed, the surgeon might be able to simply close the wound with stitches. Sometimes, they will do a "skin graft" to cover the area. But if a larger area was removed, or the surgery was complicated, the surgeon might need to rebuild the part. This is done with something called "flap reconstruction" or "flap surgery."

What is flap surgery? — 

This is a type of reconstructive surgery. It involves moving a piece of skin and other tissue from 1 part of the body to another, and reconnecting the blood vessels. The piece that is moved is called a "flap."

A flap can include skin, muscle, nerves, fat, or bone. It can have some or all these tissues in it, depending on what it is being used for. Flaps can come from different parts of the body.

What are some types of flaps used for reconstruction? — 

Flaps can come from almost anywhere in the body. A flap might be next to, nearby, or a distance from the area that needs fixing.

For reconstruction after HNC surgery, doctors usually use a "free flap." This means the flap is disconnected from its original location. The blood vessels are then reattached to vessels where the flap is placed.

Doctors often take a free flap from the:

●Forearm (figure 2)

●Scapula (shoulder blade) (figure 3)

●Thigh (figure 4)

●Fibula (lower leg bone) (figure 5)

Sometimes, instead of taking a free flap from somewhere else in the body, doctors can use a flap from nearby. This is called a "pedicled" flap. It stays connected to the blood vessels in its original location. For example, if part of the throat needs to be removed, a pedicled flap from the chest can sometimes be used for reconstruction (figure 6).

Other parts of the body can be used for flaps, too. The best choice depends on your situation, including which part is being reconstructed.

What happens during flap surgery? — 

Sometimes, reconstruction is done at the same time as surgery to remove the cancer. Other times, it is done later as a separate procedure.

●You will get anesthesia medicines so you won't feel pain. If a large flap is being used or moved, you will probably get "general anesthesia." This is medicine to put you to sleep for the surgery. In some cases, "regional" anesthesia can be used. This blocks pain in 1 part of your body, like an arm or leg.

●The surgeon will cut your skin to create the flap. The place where the flap comes from is called the "donor site." Then, they will sew it into place in its new location, called the "recipient site." They will use special tools to reconnect the blood vessels in the area.

●The surgeon will use stitches to close the wound where the flap was removed. They will cover it with a bandage.

The doctors and nurses will watch you after surgery to make sure blood is flowing to the flap.

What happens after flap surgery? — 

Most people need to stay in the hospital for some time. There, the surgeon can monitor the appearance of the flap. Once your surgeon is happy with your progress, you can go home.

Your doctor or nurse will give you specific instructions for how to care for the area. It's important to follow these instructions so your body can heal properly.

How long it will take to recover depends on the type of flap surgery you had. Your surgeon will talk to you about what you can expect the flap to look and feel like.

Even after reconstruction, you still might look or talk differently than before. Rehabilitation, or "rehab," can help. This involves specific exercises to help with speech, swallowing, and other functions.

Know that even if surgery is successful, you might not look exactly the same as before. It can also be hard to have to relearn how to do things like speaking or swallowing. If you are struggling to cope, or dealing with depression or anxiety, talk to your doctor and nurse. They can help you.

More on this topic

Patient education: Flap surgery (The Basics)
Patient education: Surgical treatment for head and neck cancer (The Basics)
Patient education: Throat cancer (The Basics)
Patient education: Tongue cancer (The Basics)
Patient education: Laryngeal cancer (The Basics)
Patient education: Esophageal cancer (The Basics)