Introduction
Head and neck cancers often require surgical removal (ablation) of tumours to achieve cure. While these operations are essential for cancer control, they can sometimes leave significant defects affecting appearance and function.
Microsurgical reconstruction is an advanced surgical technique that uses a patient’s own tissue — transferred from one part of the body to another — to restore both form and function after cancer surgery. It plays a critical role in helping patients return to normal life after treatment.
What Is Microsurgical Reconstruction?
Microsurgery involves:
- Transferring living tissue (skin, muscle, bone, or a combination) from another part of the body, called a free flap.
- Reconnecting its blood vessels to recipient vessels in the head and neck region using a microscope and super-fine sutures.
- This allows the transplanted tissue to survive permanently in its new location.
Why Is It Needed in Head & Neck Cancer?
Tumour removal can affect vital areas such as the face, nose, tongue, jaw, or scalp. Without reconstruction, patients may struggle with:
- Speech and swallowing difficulties
- Chewing and nutrition problems
- Disfigurement, affecting confidence and quality of life
Microsurgical reconstruction provides solutions by restoring both appearance and critical functions.
Most Common Types of Free Flaps Used
- Forearm Flap: Thin, pliable skin for partial tongue or mouth lining defect.
- Anterolateral Thigh (ALT) Flap: Versatile, with options of skin with or without muscle for larger defects.
- Latissimus Dorsi Flap: Muscle-based, used for extensive reconstructions (e.g. subtotal scalp resurfacing, etc), will also need skin grafting to resurface the muscle.
- Fibula Free Flap: Provides bone and with or without skin, often used to reconstruct the jaw (mandible).
The choice depends on the anticipated defect size, location, and function required after tumour removal.
The Surgical Journey
- Cancer Ablation: The tumour is carefully removed by the cancer ablation team.
- Reconstruction Phase: Microsurgical tissue transfer is performed immediately to restore structure and function.
- Postoperative Monitoring: The flap is closely monitored for blood flow to ensure survival.
- Rehabilitation: Patients may work with speech and swallowing therapists to regain function.
- Flap & Scar Revision: This might be required months down the line, once the immediate cancer treatment has been completed, to achieve the optimal appearance and function.
Recovery After Microsurgical Reconstruction
- Hospital stay: Typically 5-10 days.
- Initial recovery: Swelling and bruising are normal.
- Eating and speaking: May require feeding support initially; improvements occur with therapy.
- Return to daily life: Most patients gradually return to work and social activities in the following months.
Risks and Considerations
Like any major surgery, risks include:
- Flap failure (rare, but requires urgent return to theatre if flap threatened)
- Infection or wound healing issues
- Donor site scarring or weakness
- Functional adjustments (speech, chewing, swallowing)
- Need for subsequent revision (not uncommonly flap would require minor adjustment after all the cancer treatment has been completed)
However, when performed by experienced microsurgeons, success rates exceed 95%.
Life After Microsurgical Reconstruction
Most patients regain good function and confidence following surgery. Combined with rehabilitation and long-term follow-up, microsurgical reconstruction offers the best chance at both cancer control and quality of life restoration.
About Dr Paul Cheng
I’m Dr Paul Cheng, FRACS, Specialist Plastic, Aesthetic & Reconstructive Surgeon based on the Gold Coast and in Ballina, NSW. I specialise in both cutaneous ablation and microsurgical reconstruction for head and neck cancers, working closely with multidisciplinary cancer teams to provide both safe tumour ablation and functional reconstruction.
📅 Book a Consultation if you or a loved one has been advised to undergo head and neck cancer surgery and wish to discuss reconstructive options.