Craniofacial or Head and neck reconstruction surgery is performed to rebuild defects in the face and neck by using blood vessels, bones, tissue, muscle and skin removed from other parts of the body. These skin grafts or healthy tissue flaps are transferred to the affected area of the head or neck for reconstruction.
Some of the indications for head and neck reconstructive surgery include:
- Aesthetic abnormalities of the skull, face, jaw and ears
- Birth defects like cleft lip and palate
- Facial palsy
- Head and neck cancers including those of the oral cavity, salivary glands, tongue, larynx, pharynx, jaws and sinuses
- Facial skin cancer
- Facial trauma, infections and burns
- Botox and fillers, brow-lifts and face-lifts
- Non-healing head and neck wounds
Surgical reconstructive techniques for head and neck include:
A skin graft is a healthy patch of skin taken from another part of your body (donor site) to cover the damaged or missing area. Your doctor will choose a skin graft depending on the damaged area.
- Split-thickness skin graft: Your surgeon will use the skin layers that are close to the surface for treating burns or other injuries.
- Full-thickness skin graft: Your surgeon will use all the skin layers from the donor site to treat small defects on the face.
- Composite graft: Your surgeon will use all layers of the skin, fat and the underlying cartilage to treat wounds that have a complex shape.
Flap surgery is the transfer of a piece of tissue along with its blood vessels from one part to another part of your body. The types of flaps used include:
Local flap: Your surgeon creates a flap from the skin lying close to the wound, along with its underlying tissue and blood supply, and pulls it over the wound.
Regional flap: Your surgeon uses a tissue flap by keeping specific blood vessels attached to it. The flap is moved to cover the injured site while keeping a narrow attachment common with the original site.
Free flap or microsurgery (microvascular reconstruction): Your surgeon will remove tissue from regions away from the site of surgery and then connects the blood supply of the flap with those at the new site. This delicate work is performed under a microscope. Microvascular reconstruction includes:
- Free muscle transfer: Your surgeon will use muscles from your back or abdominal region to reconstruct the skull base or cranial vault (space in the skull). The muscles seal the complex wounds in the central nervous system and promote healing.
- Free bone transfer: Your surgeon will use the fibula (calf bone) or a part of the rib for lower jawbone, midface and orbitomaxillary (eyes and upper jaw) reconstruction.
- Free skin and fat transfer: Your surgeon will use the skin, fat or fascia (tissue surrounding muscles, nerves and blood vessels) from the forearm or thigh for reconstruction. This approach can be used for contour defects in the head and neck, tongue, nasal lining, neck skin and pharynx reconstructions.
If your mouth, lower jaw bone, neck or throat must be reconstructed, your surgeon will perform a temporary tracheotomy (opening of the airway in the windpipe) for safe to keep your airway patent and enable breathing during the procedure.
Immediately after the surgery, you will be on strict bed rest for 24 hours. You will be hospitalized about 7 – 9 days. In the initial 24 -48 hours, your surgical wounds will be checked frequently for viability.
You will be advised to keep yourself well hydrated and take measures to prevent anemia and blood clots in the veins. Your doctor will prescribe anticoagulants after a free tissue transfer. You should report to your doctor if you observe the presence of bluish color, or increased swelling and temperature in the transferred flap.
Risks and complications
As with any surgical procedure, head and neck reconstruction involves potential risks and complications. These include:
- Flap necrosis (death)
- Nerve trauma (damage and pain)
- Hemorrhage (profuse bleeding)
- Injury to the thoracic duct (major part of the lymphatic system)
- Injury to nerves in the larynx or throat