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The "free flap" surgical procedure is a method of facial reconstruction for patients following treatment for head and neck cancer. The surgeon reconstructs missing parts of the face by transplanting tissue from another part of the patient's body to the face. The goal is to return the patient, as much as possible, to their pre-cancer level of appearance and function. Dedicated facial plastic - reconstructive surgeons can transfer bone, skin, or muscle to repair almost any defect of the face. The result is aesthetically pleasing as well as functional.
Some examples of what surgeons can do during free flap procedures:
- Take a straight bone from the leg and reshape it into a new jaw, for patients who lost their jaw during cancer treatments. Working together with the dental team, implants are then placed in the new jaw bone and teeth can be restored.
- Bones from the leg or cranium can be used to rebuild the cheek bones, eye socket, and palate, if these areas had to be removed due to the cancer.
- Making a new tongue and swallowing tube for patients with tongue and throat cancer.
- Through microsurgery techniques, surgeons can restore facial symmetry in patients with facial paralysis. They do this by repairing damaged facial nerves or using implants or bands of tissue to align facial structures. (The transfers may be done in a single surgery, though some patients may need a follow-up procedure.)
Looking toward the future, facial plastic and reconstructive surgeons at Johns Hopkins may be able to offer facial transplants from donors to select patients.
Free-flap reconstructive surgery depends on what type of defect is located in the head and neck. If it involves part of the jawbone, for example, doctors need to take some tissue that involves bone. They may use part of a leg bone, for example, as the transplanted tissue brought into the head and neck. The doctor will remove the part of the bone and the blood vessels with it and then, under a microscope, sew those tiny blood vessels with sutures that are smaller than human hair. Once revascularized, the flap of tissue is viable but now in a new location.
Free flap surgery to the face may address defects of both form and function. "Free flap" implies that tissue is being harvest from a remote site on the body in a manner in which the blood vessels keeping that tissue alive are still attached to it. These blood vessels are then cut. Because the tissue will not survive without blood supply, the flap vessels are sewn into recipient vessels (arteries and veins already present in the neck or face region) to re-establish flow in and out of the flap.
A free flap may be used to help reconstruct a structure (such as the nose or the cheek). It may also be a functional flap (such as a gracilis or serratus muscle) in cases of facial paralysis. In these cases, a nerve to the muscle must also be left attached then connected to the motor nerve (facial nerve) of the face.
Facial reconstruction with free flap surgery includes the use of transfering composite tissue with the neurovascular supply intact. The microvascular replantation includes bone, muscle, nerves, and blood supply (artery and venous supply). Examples include: serratus anterior muscle, gracilus myocutaneous flap, rectus flap, radial forearm free flap, etc. These composite flaps are brought to the recipient area of the facial defect to reconstruct the jaw (mandible), the orbit, the cranium and the midface after cancer extenteration or traumatic loss of tissue. Board certified plastic surgeons with special training in microvascular replantation perform the harvesting and anastamosis under the microscope to maintain ample blood supply for flap survival.
Important: This content reflects information from various individuals and organizations and may offer alternative or opposing points of view. It should not be used for medical advice, diagnosis or treatment. As always, you should consult with your healthcare provider about your specific health needs.