Reconstruction after surgery is often desirable to minimize the functional and cosmetic changes to the patient as a result of cancer, trauma, or other surgical defects. The goal of reconstruction is for wound closure and to reestablish functions such as speaking, eating and appearance as quickly as possible. There are many considerations in determining which reconstructive option is best and having a well-trained and highly skilled surgeon is critical to success. Our surgeons have an experienced team educated in the reconstructive options and obtaining optimal outcomes. The options will be presented to you, along with risks and benefits, recovery, and reasonable expectations, to allow you and your support system to make a confident choice for your health considerations.
One of the major advancements in the treatment of patients has been the use of vascularized bone and/or tissue transplantation. With this technique, the tissue needed for reconstruction is harvested from a donor site along with the vein and artery. These are then transplanted and connected to the vein and artery near the defect and used to reconstruct the removed tissue. Drs. Kademani and Claiborne have the ability to create complex, individualized surgical plans to provide the most optimal outcome. The reconstructive decision is made prior to surgery with patient and family input, may involve surgical planning, and will be discussed in detail.
Microvascular free flaps: radial free forearm flap
There are a number of reconstructive options that may be presented to you during pre-operative appointments and individualized based on many factors. Use of the radial free forearm flap is an ideal reconstructive soft tissue option for areas such as the tongue that do not require bone for stability. A radial flap is removal of skin and tissue from inside of one wrist. The artery and vein are also harvested and transplanted to an artery and vein near the surgical site with a microscope. This is very precise and highly skilled surgery that requires a team of specialized surgeons. However, the end result is vascularized tissue that is able to heal and function within the defect. Use of a radial flap may allow you to have improved speech and swallow after a glossectomy. Since bone is not removed, it is often a quicker surgery. Surgery may be 4-6 hours long with anticipated length of hospitalization from 4-7 days. Recovery of the arm function is very likely although some people experience numbness or restricted movement often improved with physical therapy.
Microvascular free flaps: fibula flap
A fibula flap is a method of reconstruction which allows for placement of vascularized bone into the surgical site. Dr. Kademani likes to say that the fibula bone is in our body just for the purpose of rebuilding the jaw. A segment of the fibula is harvested along with the artery and vein. This is then precisely shaped to recreate the mandible or other area of the jaw. Once fully healed, it may be possible to place implants into this bone and restore the bite. This surgery is more extensive, typically lasting 8-12 hours, with anticipated length of hospitalization from 7-12 days. A leg brace and crutches are needed on the effected leg for several weeks. Physical therapy may be encouraged to restore function. Full recovery of the leg function is the norm. Although facial appearance is often altered, it is possible for full recovery of a bite after a fibula flap.
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