Head and Neck reconstruction presents a unique challenge and certain principles guide the Plastic Surgeon in the choice of the most appropriate reconstruction for any given patient. The characteristics of the disease will determine the type of treatment- surgery, chemotherapy, radiotherapy or a combination of these treatment options. The advent of microvascular reconstructive surgery has allowed Plastic Surgeons the luxury of complex reconstruction in a single stage ensuring good wound healing in preparedness for postoperative chemotherapy or radiotherapy.
Head and neck reconstruction is carried out following surgery for cancer. The diagnosis of cancer is devastating for the patient and several important decisions need to be made.
The decision making for the best treatment is done within a multi-disciplinary team of specialists all involved in the different aspects of cancer treatment. The type, position and extent of the cancer will determine the treatment process. The aim of reconstruction is to both maintain function as well as consideration of the best aesthetic result.
Reconstruction of the important tissues
Head and neck reconstruction presents unique challenges for the Plastic Surgeon as this area is visible and deformities of any kind are difficult to hide. Demands on reconstructive skills are greater in the head and neck than elsewhere in the body where cosmetic result may be less vital and function less specialised. The principles of treatment are based on the type of cancer, the size of the tumour; the resultant defect following cancer removal and the best reconstruction possible to maintain function.
Reconstruction will involve creation of specific parts for example lips, eyelids etc, also static facial nerve reconstruction for function and symmetry. The reconstruction in the head and neck region is judged on several factors and can be either local flaps or free tissue transfer. The local flap option may involve pectroalis major flaps, latisimus dorsi flaps or the deltapectoral flaps.
Microsurgical reconstruction allows the use of distant tissue from other parts of the body to create an organ that has been removed and is versatile. Common flaps are the radial forearm flap, abdominal tissue flaps, free LD flaps, anterolateral thigh flaps and several others.
Miss Patel specialises in the reconstruction of upper oesophageal defects after cancer removal. This is carried out using mircrosurgical techniques using tissues from other parts of the body to reconstruct the oesophagus. The preferred technique is the free jejunum flap, and this has become an important method for reconstructing extensive defects of the upper oesophagus and pharynx. This procedure involves the replacement of a portion of the oesophagus with a length of tissue from the small intestine. The advantages of this method are that it has a high success rate and restores the patient’s ability to swallow and to speak.
Choosing the right option
The right option is chosen by the Cancer Surgeon and the Plastic Surgeon and is dependent on other treatments that may also be required such as radiotherapy and chemotherapy. These complex decisions are discussed with the patient and the family before proceeding.
At the time of cancer diagnosis it is difficult to take in detailed explanations about complex procedures for treatment and it often takes several visits before being able to make informed decisions.
For further information please contact Miss Patel to arrange a consultation.