Microvascular reconstruction is an advanced surgical technique used to restore form and function after major head and neck cancer surgery. It involves the transplantation of tissue, such as skin, muscle, bone, or a combination, from one part of the body to another, along with the reconnection of tiny blood vessels (arteries and veins) under a microscope to ensure the tissue remains viable. This procedure plays a critical role in complex head and neck reconstruction, especially after cancer removal involving the mouth, jaw, throat, or facial structures.
When Is Microvascular Reconstruction Needed?
This form of reconstruction is most often used following:
- Removal of oral, oropharyngeal, or laryngeal cancers
- Resection of tumors involving the jawbone, tongue, or throat
- Surgery for advanced skin cancers or salivary gland tumors
- Reconstructive needs after trauma or previous cancer treatments
The goal is to restore essential functions such as speech, swallowing, chewing, and facial expression, as well as to preserve appearance and quality of life.
Commonly Used Tissue Types
Tissue (known as a “free flap”) is selected based on the location and type of defect. Common donor sites include:
- Fibula Free Flap: Bone from the lower leg, often used to reconstruct the jaw (mandible)
- Radial Forearm Free Flap: Skin and soft tissue from the forearm, ideal for rebuilding tongue or throat lining
- Anterolateral Thigh Flap: Soft tissue from the thigh, used for larger or more complex reconstructions
- Scapular Free Flap: Bone and soft tissue from the shoulder blade region, used for midface or jaw defects
The Procedure
During surgery, the cancer is removed, and the reconstruction team prepares the donor site tissue. Under a high-powered surgical microscope, the tiny arteries and veins from the transplanted tissue are connected to blood vessels in the neck, allowing immediate blood flow and integration. The procedure is highly intricate and can last several hours.
Recovery and Outcomes
Patients typically spend time in a specialized surgical unit for close monitoring of flap viability. With proper care, free flap survival rates are very high. Most patients begin working with speech and swallowing therapists shortly after surgery to regain function.
Expertise Matters
Successful microvascular reconstruction requires close coordination between head and neck cancer surgeons and reconstructive microsurgeons. At UC Irvine, these teams work together to deliver advanced, patient-centered care that maximizes both oncologic outcomes and quality of life.