Head & Neck Cancer Surgery

Reconstructive Options

Sometimes removing a cancer leaves a large gap or defect that if not filled would severely impair a patient’s life, looks, and function; the gap also could expose an artery after the muscle covering and protecting it has been removed. A “tissue flap” — tissue (skin, fat, fascia, muscle) from one area of the body, including its arteries and veins — is used to reconstruct (fill) that gap or cover the exposed artery. Flap tissue is usually taken from the forearm, chest, or leg. A “skin graft” is when a very thin piece of skin is shaved off of an area of the body (usually the leg) to cover a defect.

Common Tissue Flaps

• Forearm flap: This may cause some numbness to parts of the hand, but overall function should remain good. We try to take the flap from the non-dominant hand.  Initially, a splint will be wrapped around the arm; it is removed in five to seven days. 
  
• Thigh flap: This should not affect the ability to walk.
• Pectoralis flap: This flap is taken from the muscle on the chest. It should not affect the ability to move the arms.
• Fibula flap: Initially, after a fibula flap is taken a splint will be wrapped around the leg; it is removed in five to seven days. After the splint is removed, the ability to walk and bear weight should not be affected.

Skin Grafts

• How it is used: A skin graft is sutured on top of a flap donor site to cover and protect the exposed tissues underneath.
• Post-operative Instructions:
  • Donor site instructions: A dressing will be placed during the surgery and will be taken of usually 2 weeks afterwards in clinic. It is important to keep the dressing dry. Once it is removed, you can wash the area with soap and water.
  • Graft placement site instructions: A splint will be placed on top of the graft to hold it in place for five to seven days after surgery and will be removed before the patient leaves the hospital. After it is removed, your doctor will examine the site to determine how much of the graft “took.” A new dressing will then be placed on the wound and will need to be changed daily.
• How it heals:
  • Donor site graft: When the dressing is removed, it will probably look like a larger version of a healing scab, similar to after you scrape your knee when you fall. You can wash it with soap and water, and use Vaseline to keep it moist.
    
      
  • Graft placement site: Initially, it will probably look somewhat transparent or bruised. Once completely healed, the graft will look like regular skin with a surrounding scar. Its color may be different from the surrounding skin because it keeps the color and usually the hairiness of the area of the body from which it was taken.