Microvascular head and neck reconstruction is a technique for rebuilding the face and neck using blood vessels, bone and tissue, including muscle and skin from other parts of the body. The technique is one of the most advanced surgical options available for rehabilitating surgical defects that are caused by the removal of head and neck tumors.
This technique involves harvesting flaps of healthy tissue — where the tissue is not as important — with the blood supply from remote sites in the body. The tissue is then transferred to the recipient wound bed, where it is much more useful in reconstructing the affected area of the head and neck. A microscope is used to suture the blood vessels of the flap to blood vessels in the neck, allowing the tissue to live as if it were back in its original location.
Microvascular head and neck reconstruction is used to treat head and neck cancers, including those of the larynx and pharynx, oral cavity, salivary glands, jaws, calvarium, sinuses, tongue and skin. Cancer treatment usually involves some combination of surgery, radiation therapy and chemotherapy — any of which can result in significant treatment-related side effects. Treatment of head and neck cancer can affect the appearance of the face and neck, as well as various functions, including: speech, sight, smell, swallowing and taste. Microvascular surgery is used to return the head, face and neck to as close to normal as is possible.
The technique is also used to treat other conditions including:
If you undergo this treatment, there are many things you will need to do to prepare for a free tissue transfer. If being performed as a treatment for a malignant tumor of the head and neck, then the procedure will be performed by two surgical teams. One team dedicated to removal of the tumor and any potential involved lymph nodes. And a second team dedicated to reconstruction of the defect.
You will need to meet the surgeons in charge of both teams prior to the operation and you may be required to undergo extensive testing, including: imaging, cardiac and pulmonary testing and possibly tumor mapping and biopsy. Your case will be presented before our multidisciplinary malignant tumor board and our entire team of neuroradiologists, medical oncologists, radiation oncologists, surgical oncologists and microvascular reconstructive surgeons, who will compose a comprehensive treatment plan.
Do not eat or drink after midnight. Take your regular medications the day before and the morning of the procedure with a small amount of water.
After the procedure, you may be in the hospital for seven to 10 days. Bring your medications so they can be added to your post-operative regime, if appropriate. Slipper-socks and robes are provided. Please bring reading materials, music CDs or a video to watch in the patient waiting area. Remember to leave your valuables, such as jewelry and large sums of cash at home.
The procedures take place either at the UCSF's Mount Zion campus or UCSF Medical Center at the Parnassus campus. Make certain you know which hospital will be the location for your operation. An escort will take you to the pre-operative area. A family member or friend may accompany you there. You will be asked to put on a hospital gown and a nurse will start an intravenous (IV) line through which you will receive fluids and a mild sedative during the procedure. The same IV is used to administer the contrast agent for your imaging studies.
Several types of microvascular reconstruction techniques may be used, including:
If the reconstruction is targeting your mouth, lower jaw bone, neck or throat surgeons will often perform a temporary tracheotomy to ensure that your breathing will be safe. They may also place a temporary feeding tube to ensure that you may be fed while your wounds heal.
After surgery patients are often sedated for the first night, and awoken the morning following surgery. Patients typically spend two days in the intensive care unit, followed by an additional five to seven days in a regular hospital room before discharge. Patients will be assessed by physical therapy and in the event of extensive wound care or rehabilitation needs, they may be transferred to a rehabilitation hospital or be discharged with home nursing care.
Reviewed by health care specialists at UCSF Medical Center.
Head and Neck Cancer
1825 Fourth St., Fourth Floor
San Francisco, CA 94158
Phone: (415) 885–7528
Fax: (415) 885–7711
Facial Plastic and Reconstructive Surgery
2330 Post St., Fifth Floor
San Francisco, CA 94115
Phone: (415) 353-9500
Fax: (415) 885-7800