Reconstructive Flap Surgery

What is reconstructive flap surgery?

Reconstructive flap surgery is a specialised surgical procedure that is often employed to repair areas affected by certain head and neck conditions, such as head and neck cancer , head and neck tumours (link to head and neck tumours page), or head and neck lumps. The procedure typically involves the transfer of healthy tissue from one part of the body to the affected area. Additionally, the procedure is essential in restoring functionality, such as the ability to swallow, speak, and breathe, as well as addressing cosmetic concerns.

A reconstructive flap surgery can help restore functional abilities, and appearance following a cancer, or tumour resection, which results in extensive tissue loss.

Depending on the severity of the tissue, and structural damage, our surgeons may opt for one of the three types of flaps:

Free flap

Local flap

Regional flap

Suitable for large, and complex tissue damage, which often requires substantial amounts of tissue.
The blood vessels are totally disconnected and reconnected using microsurgery to ensure blood flow is restored.

Free flap surgery requires more extensive planning, with a longer surgery time.

Suitable for smaller tissue damage.

A less invasive procedure compared to free, and regional flaps.

The blood supply remains connected throughout the procedure.

Suitable for extensive, and large tissue damage.

Often employed when a substantial amount of tissue is required. , without undergoing flap surgery.

The blood supply is partially connected throughout the procedure.

How does reconstructive flap surgery work?

During reconstructive flap surgery, healthy tissue is often taken from a donor site and transferred to the head or neck region that needs to be repaired. Some of the common donor sites include:

The back.
The forearm.
The thigh.
The chest.
The lower leg.

The procedure involves several detailed and tedious steps to ensure a successful procedure;

Assessment:	Prior to the surgery, the surgeon will assess the size, extent, location and structural damage. Depending on the tissue and structural damage, our surgeon will decide between local, regional, or free flaps, with preoperative imaging used to map out the necessary blood vessels. Additionally, our surgeons will also carefully choose the donor site based on the patients’ needs.
Flap harvesting:	For local, and regional flaps, healthy tissues are taken from nearby areas to preserve their original blood supply. On the other hand, free flaps are usually harvested from distant sites such as the forearms, and thighs. The flaps include the skin, muscles, and blood vessels.
Transfer and Connecting:	The flap is transferred to the damaged tissue site within the head and neck region and carefully positioned to cover the damage. For free flaps, a microsurgery will be performed to reconnect the blood vessels and restore blood flow.
Securing the flap	Once the flaps are in position, they are secured with sutures or other fixation methods. Afterwards, our surgeon will proceed to 'shape’ the flap to match the contours of the damaged area to ensure optimal functional, and aesthetic results.
Postoperative care and Monitoring	After both surgical and donor sites have been closed, you will be put under close observation, especially for those who have undergone free flap surgery. This is to ensure viability, and that the blood flow has been restored.

When is a reconstructive flap surgery recommended in Singapore?

Reconstructive flap surgery is a crucial component of comprehensive patient care for patients diagnosed with complex head and neck conditions, such as head and neck cancer. As such, the procedure is often recommended for the following situations:

Complex or large tumours that impact critical structures.
To correct birth defects that impact the functionality or structure of the head and neck regions.
Extensive tissue loss due to excision, resection, traumatic injuries or radiation therapy.
Functional restoration; such as enhancing the ability to speak, swallow and breathe.
Improving the appearance of the head and neck region.
Reverse structural damage due to head and neck conditions, traumatic injuries or radiation therapy complications.

Doctors often obtain donor tissue from the back, forearms, or the thighs.

What are the benefits of reconstructive flap surgery?

Some of the benefits that come from undergoing reconstructive flap surgery include:

Enhancing quality of life.
Improving cosmetic appearance.
Minimising the risk of complications.
Promoting quicker recovery and healing time.
Reducing the need for multiple treatment surgeries.
Reducing the risk of infection.
Restoring functional abilities.
Offering customisable treatment to tailor to your specific needs.

What can I expect after a reconstructive flap surgery in Singapore?

Following the procedure, you will be put under close observation to monitor your vital signs as well as to ensure blood flow has been successfully restored (for free flap). As such, you will be required to stay at the hospital for a couple of days or up to a week, depending on the type of flap surgery you underwent and your overall condition.

Additionally, our surgeon will advise you to adhere to some aftercare procedures, such as:

Pain management: our surgeons will prescribe you painkillers to help relieve any pain, or discomfort that you may experience while recovering. While these are common post-surgery aftereffects, the pain, and discomfort will gradually reduce over a couple of days.
Wound care: aside from having your surgical sites closely monitored to identify any risk of infection, inflammation or flap failure, your dressing may be changed regularly to reduce the risk of infection and complications.
Physical therapy: our surgeon may also recommend physiotherapy to restore functional abilities to facilitate the recovery process.

A reconstructive flap surgery is a complex, and tedious procedure that yields positive outcomes.

How many treatment sessions are needed?

Generally, reconstructive flap surgery only requires one session. However, this can vary based on the complexity and severity of the tissue or structural damage. While a second reconstructive flap surgery is highly unlikely, our surgeons may recommend additional treatments or procedures to fine-tune the surgical outcome and facilitate the recovery process.

If you would like to learn more about reconstructive flap surgery, get in touch with us (link to contact us page) today to speak to our expert.

Frequently Asked Questions

How painful is reconstructive flap surgery?

During the procedure, you will not be experiencing any pain as you will be under anaesthesia. However, once you regain consciousness, and the anaesthesia wears off, you will experience some soreness, tenderness and discomfort. These are easily managed with painkillers.

How long does it take to recover from reconstructive flap surgery?

It usually takes 2 weeks to make a full recovery.

How long does the procedure usually take?

Free flap surgery can take up to 12 hours to complete, while local and regional flaps take a significantly shorter amount of time – about 1 to 4 hours.

How does reconstructive flap surgery differ from skin grafting?

Reconstructive flap surgery involves a piece of tissue, along with its blood supply (which may include the skin, bone, and muscle), that is moved from one part of the body to another. The procedure restores complex functions and structures to damage that is sustained within the head and neck region. Skin grafting on the other hand involves transplanting the skin solely(without blood supply). It is more suitable for covering superficial or surfaced damages.

Will the procedure result in scarring?

Yes, scarring is a possibility in both the donor and treatment areas. However, scarring can be minimised when the procedure is conducted by more experienced surgeons.

Are there any risks associated with the procedure?

As with any surgery, there are some risks associated with the procedure, albeit very low.
Some of the risks include:

Bleeding.
Flap failure or poor blood circulation.
Infection.
Poor wound recovery.

Thyroid & Parathyroid

Head & Neck

Skin