Head & Neck

Free flap surgery is a complex microsurgical technique where tissue, including skin, muscle, bone, or a combination, is transferred from one part of the body (donor site) to another (recipient site) to reconstruct defects resulting from cancer surgery, trauma, or congenital abnormalities in the head and neck region. Various anatomical donor sites have been identified where complex tissue can be harvested with its own blood supply, minimising donor site complications.

These donor sites include pedicled or regional flaps, which are anchored near the head and neck using a pedicle (stem or stalk of tissue). Alternatively, tissue can be transferred from distant sites with their artery and vein connected (free tissue transfer or free flaps), ensuring a robust blood supply. Soft tissue flaps can be local, regional, or distant (free flaps); and are chosen based on the size, location, and complexity of the defect needing reconstruction. While ideally, like-for-like tissue replacement is preferred, substitute tissues are often used when exact matches are not feasible.

Local flaps are typically used for smaller defects in the face, scalp, and neck that cannot be closed directly or with skin grafts since they are limited by size and rotational range from their attachment point. Regional flaps are based on named arteries and can include multiple tissue types; some of the regional flaps that Dr Basheeth performs include the Pectoralis Major Flap, which comprises muscle alone or muscle with overlying skin, Supraclavicular Flap, Submental Flap, KPIF Flap and Paramedian Forehead Flap among others. These flaps have long been pivotal in head and neck reconstruction but are constrained by their anatomical attachments.

Head and neck cancers, particularly in the oral cavity, often involve the upper and/or lower jaw bones. Removal of bone to eliminate tumours can create significant functional deficits. Free flaps containing bone, such as the fibula, iliac crest, or scapula, are employed to reconstruct these defects and restore form and function following surgical removal of cancerous tissue.

Free flaps offer extensive versatility, better tissue matching and an unlimited rotational reach. Donor sites for free flaps include the radial forearm, ulnar forearm, lateral arm, scapular and parascapular regions, latissimus dorsi, rectus abdominis, anterolateral thigh, Fibular free flap, gracilis, tensor fasciae lata etc. They are highly reliable and suitable for reconstructing complex, large and multi-component defects.