Free Flap Surgery

Surgery is a common approach for addressing head and neck cancers. While it can be highly successful when tumors are localized, surgical procedures typically entail the excision of skin and adjacent tissues. This process may result in the formation of wounds that are too large, and the tissue removed with the cancer must be replaced. This reconstructive process may involve a surgical technique referred to as free flap surgery.

A free flap is when tissue is taken from one part of the body and then transplanted to another part of the body to fill a soft tissue and/or bony defect created from the cancer resection. Small arteries and veins are microscopically sutured back together to provide blood going into and out of the transplanted tissue. Due to this, one of the potential complications of the surgery is a clot forming in the artery or vein leading to loss of the free flap. For this reason, special techniques are used to monitor the flap including an implantable doppler.

The type of free flap surgery that your surgeon recommends will depend upon multiple factors, including the area of the wound and your individual needs and preferences. Types of free flap surgeries include:

• After surgery, you will wake up in the recovery room. You’ll spend about five days in the Intensive Care Unit (ICU) for close monitoring and initial recovery. You will be frequently monitored by a nurse who will watch your vitals (pulse rate, respiration rate, blood pressure, etc.), transplanted tissue and help manage any pain that you might have.
• You will remain in the hospital for approximately two weeks to ensure proper healing, pain management and to address any post-surgery concerns.
• You may have a tracheostomy inserted during surgery which is a temporary breathing tube inserted through a small incision in your neck to assist with breathing while you heal. Your medical team will monitor and care for the tracheostomy site.
• You also may notice multiple drains placed near the surgical site to help remove excess fluids and prevent complications. These will be removed when drainage reduces to an appropriate level.
• You will have nothing to eat or drink after the procedure for about 10 to 14 days to allow for healing. During this time, all medications and nutrients are given through a feeding tube placed in the nose (NG) or directly into the stomach (G-tube). This is a temporary measure that will be removed once you are healed and can eat and drink normally.
• In addition, a wound vacuum-assisted closure (wound vac) may be applied to enhance wound healing. This uses negative pressure to promote tissue growth and reduce infection risk.