Microvascular reconstruction is a surgical procedure that involves moving a composite piece of tissue from another part of the body to the head and neck. The tissue most commonly comes from the arms, legs, or back, and can include bone, skin, fat, and/or muscle. The details of what is moved and where it is moved from are dependent on the reconstructive needs. Transfer of the tissue to the head and neck allows us to do things such as rebuild a jaw, optimize tongue function, or reconstruct the throat.
When these pieces of tissue are moved, they require their own blood supply for survival in their new location. This is similar to how a transplant works, except we are using a patient’s own body to provide the reconstructive tissue. After the reconstruction is carefully secured in the head and neck, the blood vessels that feed the tissue transplant are reconnected to new blood vessels in the neck. Since these blood vessels are usually 1 to 3 millimeters in diameter, the connections must be done with a microscope - hence, the term “microvascular surgery.”
This type of reconstruction may also be combined with other advanced surgical techniques, such as computer modeling, 3D printing, and customized implant fabrication. Prior to surgery, patients undergo careful assessment of functional impact and necessary rehabilitation planning.
Procedure of Microascular Reconstruction
Several types of microvascular reconstruction techniques may be used, including:
- Free muscle transfer — In this procedure, a surgeon harvests a muscle from the latissimus (back) or rectus abdominus (abdominal region) for reconstruction of the skull base or cranial vault. Muscle is particularly useful for sealing off the central nervous system and for promoting healing of complex wounds.
- Free bone transfer — Bony defects are often among the most difficult reconstructions as precise alignment of bone is required, as well as cutaneous (skin) coverage. Bone is most commonly used for mandibular reconstruction, but new innovation allows its use for midface and orbitomaxillary reconstruction. If the fibula is not available for transfer, another option is the latissimus-serratus-rib free flap. This allows the transfer of an abundant volume of bone, muscle and skin in patients, even with advanced peripheral vascular disease, although the bone quality is not as good when compared with the fibula bone.
- Free skin and free fat transfer — The radial forearm has long been the dominant flap used for cutaneous coverage. However, the anterolateral thigh flap is being used more in head and neck reconstruction because it has proven to be an ideal donor site with reliable vascularity, ease of harvest and versatility. Tissue types that may be safely harvested from this donor site include: skin, skin and fat, fat and fascia or fascia alone. The abundance of tissue available and the minimal morbidity from this site permits reconstruction of contour defects of the head and neck, pharyngeal reconstruction following laryngectomy, mucosalized tongue reconstruction and reconstruction of nasal lining and neck skin.
The technique that allows this precise targeting within the brain is called stereotaxy. Stereotactic radiosurgery is performed with the aid of imaging techniques called CT Scan, MRI and angiography.
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.
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:
- Osteoradionecrosis of the mandible, which is a serious complication of radiation therapy to the head and neck
- Oronasal fistula, which is a hole between the mouth and nose cavity
- Nasal obstruction
- Trismus, which is an involuntary contraction of the mastication muscles
- Velopharyngeal insufficiency, which is a disorder resulting in the improper closing of the velopharyngeal sphincter (soft palate muscle in the mouth) during speech
- Contour irregularities of the face and neck following surgery
- Non-healing wounds of the head and neck
- Nasal stenosis or deformation following cancer surgery