What is a free flap reconstruction?

A free flap is a piece of tissue, such as skin, muscle or bone, taken from another part of the body together with its blood vessels, and transplanted to the head and neck where its artery and vein are joined to vessels in the neck under a microscope. It provides living, healthy tissue to rebuild the tongue, jaw, cheek or throat.

Is reconstruction done at the same time as cancer surgery?

Yes, wherever possible. Dr. Patel plans the removal and the reconstruction together and performs both in the same operation, so that patients wake with the defect already rebuilt. Secondary reconstruction is offered for defects from earlier surgery.

How long does it take to recover from reconstructive surgery?

Most patients are in hospital for seven to ten days after free-flap surgery. The donor site heals in two to three weeks, and swelling in the reconstruction settles over two to three months. Speech and swallowing continue to improve with therapy for six to twelve months.

What are the risks of free-flap surgery?

The main specific risk is a problem with the blood supply of the flap in the first few days, which occurs in a small percentage of cases and is treated by urgent re-exploration. Flap success rates in experienced hands exceed 95 percent. Donor site problems, infection and fistula are uncommon and usually manageable.

Will the reconstructed area look and feel normal?

Reconstruction restores shape and volume very well, and colour and texture improve over time. Transplanted tissue has little sensation initially, although some returns over months. Most patients report that the reconstructed area feels natural in daily life within a year.

Can I have dental implants after jaw reconstruction?

Yes. A fibula flap provides bone strong enough for implants, which can be placed at the time of reconstruction or after healing and radiotherapy. Virtual planning positions the bone so that implants and a fixed prosthesis can restore chewing.

Reconstructive Surgery Specialist in Ahmedabad

Reconstructive surgery in Ahmedabad that rebuilds form and function after head and neck cancer.

Removing a head and neck cancer completely can leave a defect in the jaw, tongue, cheek or throat. Reconstructive surgery, performed in the same operation, rebuilds these structures using tissue from elsewhere in the body so patients can speak, swallow and face the world with confidence. Dr. Parin Patel plans resection and reconstruction together from the outset.

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What is head and neck reconstructive surgery?

Curing a head and neck cancer means removing it with a margin of healthy tissue. In the mouth, jaw, face and throat, that margin may include the structures we use to eat, speak, breathe and express ourselves. Reconstructive surgery replaces what has been removed with living tissue from elsewhere in the patient's own body, restoring shape and function. It is not a cosmetic afterthought: reconstruction is what makes complete, curative cancer surgery possible without leaving patients unable to swallow or with a disfigured face.

Dr. Parin Patel's principle is that the resection and the reconstruction are one operation. The defect is anticipated from the scans, the reconstruction is chosen before surgery, and the two are performed in the same anaesthetic, so that patients wake with the jaw, tongue or cheek already rebuilt.

Who needs reconstruction?

Patients having surgery for oral cancer, mouth cancer or tongue cancer, where part of the tongue, cheek, floor of mouth or jaw is removed
Patients having a segmental mandibulectomy or maxillectomy for cancers invading the jaw or palate
Patients having throat or laryngeal surgery where the swallowing passage must be rebuilt
Patients with paranasal sinus and skull base cancers, where the barrier between nose and brain and the facial contour are reconstructed
Patients with skin cancers of the face and scalp, or defects after parotid surgery
Patients with facial trauma or defects from previous surgery seeking craniofacial correction
Patients whose previous reconstruction has failed or who have complications after radiotherapy, such as exposed bone

Reconstructive techniques

Reconstruction follows a ladder, from the simplest method that will do the job to the most complex. Dr. Patel selects the technique according to the size and location of the defect, the tissues removed (lining, muscle, bone, skin), whether radiotherapy will follow, and the patient's general health.

Primary closure and skin graftsSmall defects of the cheek, tongue or palate are closed directly or resurfaced with a thin skin graft. Simple, quick and effective for superficial lesions.

Local flapsAdjacent tissue is rotated into the defect: nasolabial flaps for the floor of mouth, buccal fat pad for the cheek, palatal flaps and forehead flaps for the nose. Good colour match and a single operative site.

Regional pedicled flapsMuscle and skin from the chest (pectoralis major) or back (latissimus dorsi) is tunnelled into the neck on its own blood supply. A robust, reliable option for large defects and for patients unsuitable for microsurgery.

Microvascular free flapsTissue with its own artery and vein is transferred from a distant site and reconnected to neck vessels under a microscope. The gold standard for complex defects, allowing tailored replacement of lining, bulk, bone and skin.

Free flaps used in head and neck reconstruction

Radial forearm flap: thin, pliable skin for the tongue, floor of mouth, cheek lining, palate and pharynx
Anterolateral thigh flap: larger, adaptable skin and fascia for cheek, tongue, throat and skull base defects, with a concealed donor scar
Fibula flap: a length of leg bone with skin for rebuilding the lower jaw or upper jaw, strong enough to hold dental implants
Iliac crest and scapula flaps: alternative bone sources for jaw reconstruction
Jejunal flap: a segment of small bowel for circumferential reconstruction of the pharynx

What reconstruction restores

01
Swallowing and eating
A rebuilt tongue, palate or pharynx keeps food moving safely from mouth to oesophagus. A reconstructed jaw with implants restores chewing.
02
Speech
A mobile, appropriately sized tongue and an intact palate are what make clear speech possible. Free-flap reconstruction, followed by speech therapy, achieves intelligible speech in the great majority of patients.
03
Facial appearance
Restoring the contour of the jaw and cheek, the support of the eye and the coverage of the skin preserves a natural face and the confidence to return to social and working life.
04
Protection and healing
Well-vascularised tissue covers vessels and bone, separates the brain from the nose and throat, and tolerates the radiotherapy that often follows surgery.

Our article how reconstructive surgery specialists are restoring function and confidence explores these outcomes, and restoring function and appearance after oral cancer surgery focuses on the mouth.

Why Dr. Parin Patel

Head, Neck and Skull Base Surgical Oncologist with more than thirteen years' experience, who performs both the cancer resection and its reconstruction
Microvascular free-flap reconstruction integrated with margin-controlled cancer surgery in a single operation
Virtual surgical planning and dental implant rehabilitation for jaw reconstruction
Reconstruction of skull base and craniofacial defects drawing on Skull Base Fellowship training at Tata Memorial Centre
Structured post-operative monitoring and rehabilitation at HCG Aastha Cancer Centre

Recovery after reconstructive surgery

After free-flap reconstruction, the flap is monitored closely for the first three days, when the risk of a blood-vessel problem is highest, and patients are usually in hospital for seven to ten days. A feeding tube protects the reconstruction for one to two weeks. The donor site, on the forearm, thigh or leg, heals over two to three weeks and rarely causes lasting problems. Swelling in the new tissue settles over two to three months. Speech and swallowing therapy begins before discharge, and dental rehabilitation is planned once healing is complete and after radiotherapy if that is required. Our rehabilitation programme coordinates each of these steps.

Oral cancerThe most common reason for reconstruction.Tongue cancerFree-flap tongue reconstruction.Craniofacial surgeryRebuilding the facial skeleton.RehabilitationSpeech, swallowing and dental recovery.Skull base surgerySkull base reconstruction after tumour removal.Book a consultationDiscuss resection and reconstruction together.

Patient questions

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Related treatments

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