At NOLA Craniofacial, we offer a wide range of reconstructive options for patients recently diagnosed with cancers of the jaw and throat; for those who have endured previous surgery to remove a tumor; and for those whose lives have been shattered by traumatic injury.
Among the most exciting — and most complex — of these options is our ability to repair wounds with healthy “own” tissue.
This healing tissue might include skin and perhaps some portion of its supporting musculature. Often, we will remove a segment of bone from a donor site to aid in reconstruction. We call these procedures “free flap” transfers.
The “micro-” in microsurgery comes when it is time for the surgeon to re-attach those tiny blood vessels to blood vessels in the affected area. This meticulous procedure provides the necessary blood supply in order for the wound to heal and, ultimately, sustains and nourishes the healthy tissue in the new location.
“Own Tissue” Microsurgical Reconstruction
Skilled craniofacial surgeons like Dr. Hugo St. Hilaire are now able to transfer tissue from one part of the body (where perhaps it serves a less vital cosmetic function) to repair injuries to the face, head, and neck.
For many patients, this is a life-changing procedure.
For some, it is life-saving.
At NOLA Craniofacial, we specialize in care of patients suffering from acute, post-ablative or post-traumatic wounds. We have also recommended microsurgical reconstruction to alleviate suffering caused by chronic infection and by complications following radiation.
Microsurgical Reconstruction of Craniofacial Wounds and Defects
Microsurgery enables the transfer of healthy “own” tissue, along with its vascularity from one area of the body to another.
In the right patient, microsurgical free flap transfer of tissues from a donor site can help to alleviate both physical pain and psychological trauma associated with cosmetic disfigurement. Indeed, microsurgery is commonly used by craniofacial surgeons like Dr. Hugo St. Hilaire to restore function and appearance in the mid-face and jaw. Microsurgery has also become the gold-standard in reconstructive breast care following a mastectomy.
There are several areas of the body that provide ample healthy tissue without compromising function at the donor site. These include the fibula, or lower leg, the shoulder blade, the hip, and the thigh (as a source of a skin flaps).
The most common donor site for microsurgical reconstruction involving bone is the fibula.
The fibula is the smaller of two bones in your lower leg, extending from the knee to the ankle. Interestingly, it is not a weight-bearing bone. While the fibula is necessary for higher athletic function, most of us would get along fine without it.
Borrowing flesh and bone from the lower leg allows maximum flexibility in reconstructing defects in the jaw and mid-face. Donor site morbidity is rare. Better yet, a skilled surgeon can usually ensure minimal scarring, andthe leg functions normally following surgery.
The scapula, or shoulder blade, provides ample bone to support major craniofacial reconstruction.
The shoulder blade also allows your surgeon to borrow skin and muscle in the form of a “chimeric flap,” which is a flap with multiple vascular “pedicles.” A flap, in other words, that has more than one way to access a healthy blood supply. (A pedicle is a collection of blood vessels that supports healthy tissue.)
The only disadvantage is that we must re-position the patient during surgery.
Another option for craniofacial surgeons is a flap of skin and bone that is fed by the Deep Circumflect Iliac Artery (DCIA). This flap offers excellent bone to support a reconstruction, but depends on a shorter pedicle.
Craniofacial reconstructions that require muscle — i.e. a functional free flap — often “harvest” from the gracilis muscle of the medial thigh. The thigh is also a good source of skin to aid in the reconstruction of post-traumatic and post-ablative wounds.
In addition to flaps from the medial thigh (where a scar almost disappears in the musculature), we have frequently used skin from the inner thigh. Again, a skilled surgeon can easily hide the scar at the donor site and in most cases it will be inconspicuous.
In rare cases, tissue may be harvested from the forearm. The skin of the anterior forearm is usually hairless and this offers certain cosmetic advantages.