Patients who are diagnosed with cancer of the head and neck are often treated with surgery. Removal of tumors in the mouth and the throat can significantly inhibit speech and swallowing. Similarly, removal of the bone involved with cancers of the jaw affects appearance and function of patients. In some cases, the wounds, left as a result of cancer surgery, can be allowed to heal or be covered with the surrounding tissues. Often, however, the wounds are too big, and the tissue removed with the tumor must be replaced. In such circumstances, a “free flap” may be a sound option for repairing the defect.
Local Flaps Versus Free Flaps
A flap is any piece of tissue that is moved to cover a wound. A free flap is a piece of tissue that is disconnected from its’ original blood supply, and is moved a significant distance to be reconnected to a new blood supply. Let us use a lamp as an example. When a lamp has to be moved from one part of the table to another it may not need to be unplugged. This is similar to a “local” flap that is “rotated” into the wound. The electric cord is analogous to the blood vessels delivering blood to the flap. When the lamp must be moved from one side of the room to another, the cord cannot stretch the required distance. In these cases the lamp is unplugged (“free”), brought to its’ new location and plugged into another outlet.
Similarly, a free flap is taken from the body of the patient; the blood vessels that bring the blood in and out of the tissue are cut, and then reconnected to another source of blood (usually in the neck). The artery that comes with the flap is sewn to the artery in the neck to bring the blood in, and the vein is sutured to a vein in the neck, re-establishing the blood flow. The blood vessels feeding the flap are usually very small and the “re-plugging” of the flap is done through microvascular surgery. Microvascular surgery is a technique of sewing two small blood vessels together under a microscope.
The surgeon has to select tissue in the body that will do the best job of restoring the function and the appearance of head and neck tissues destroyed by the tumor. The commonly used free flaps include: forearm or thigh skin (thin skin that can be used to rebuild the inside of the mouth and throat), muscles from the abdomen or the back, and fibula bone (bone on the outer side of the leg).
The success of using a free flap in reconstruction after head and neck cancer surgery is 95-98 percent. The goal of the reconstructive surgeon is to return the patient to a state where they can enjoy eating, swallowing and speaking. With the advancements in the field of microvascular and reconstructive surgery, this goal is often achieved.
Mohemmed Nazir Khan, MD
Assistant Professor, Department of Otolaryngology at Mount Sinai-Union Square
Dr. Khan’s clinical interests and expertise include the medical and surgical management of benign head and neck tumors; thyroid and parathyroid disorders; salivary gland disorders; head and neck cancers; and reconstructive surgery involving the head and neck. In addition to his professorship, he is the Associate Director of the Head and Neck Cancer Research Program at the Icahn School of Medicine at Mount Sinai. Dr. Khan is available for rapid referrals and same day appointments.