Head & Neck Reconstruction
Reconstructing complex defects after cancer surgery while protecting function, healing and form.
Head and neck defects can involve several tissue types and several functions at once. Reconstruction may need to restore internal lining, external skin, soft-tissue volume or structural support while also supporting speech, swallowing and protection of vital structures.
The reconstructive plan is therefore developed around the anticipated defect and the wider oncological treatment.
The defect defines the reconstruction
Two defects in the same anatomical region may require very different solutions. The important questions are what has been removed, which surfaces need to be reconstructed, what function needs to be preserved and what tissue characteristics are required.
Where possible, reconstruction is planned before the cancer operation so that the resection and reconstructive strategy can be considered together.
What may need to be restored
Internal lining
Defects of the oral cavity, pharynx or other mucosal surfaces may require thin, pliable tissue capable of creating a durable internal lining.
Soft-tissue volume
Resection can leave loss of three-dimensional volume as well as surface tissue. Reconstruction may need to replace bulk and restore separation between anatomical spaces.
External cover
Skin and soft-tissue loss may require reliable vascularised cover, particularly where important structures are exposed or previous treatment has compromised local tissues.
Structural support
Some defects involve bone or other supporting structures. Reconstruction then needs to consider stability, facial contour and the functional requirements of the reconstructed region.
Microsurgery in head & neck reconstruction
Free-tissue transfer is particularly useful when a defect requires healthy tissue with specific characteristics that cannot be provided reliably by tissues next to the wound.
Tissue can be selected for thinness, volume, skin, muscle or structural requirements and transferred together with its blood supply. The vessels are then reconnected to recipient vessels in the neck under magnification.
The choice of donor site is made according to the reconstructive requirement and the consequences of taking tissue from that site.
Function matters
Head and neck reconstruction is closely linked to function. Depending on the defect, priorities may include speech, swallowing, oral competence, tongue mobility, separation of the mouth from the neck, protection of vessels or restoration of structural support.
No reconstruction can recreate normal anatomy perfectly after a major resection. The aim is to use the available tissues to provide the most appropriate functional and anatomical reconstruction that the defect allows.
Form matters too
Functional reconstruction and appearance are not separate objectives. Volume, contour, scar position and the relationship between reconstructed and unaffected tissues influence how the result looks and how it functions.
These considerations are incorporated into planning from the outset rather than treated as an afterthought.
Reconstruction and cancer treatment
Before surgery
Discussion with the ablative surgical team helps define the likely defect and allows reconstructive options, donor sites and contingencies to be planned in advance.
At the operation
The final reconstruction is adapted to the actual defect once resection is complete. In complex cases this requires close communication between the oncological and reconstructive teams.
Radiotherapy
Previous or planned radiotherapy can influence tissue quality, wound healing and reconstructive choices and is considered when developing the operative plan.
Rehabilitation
Recovery may involve speech and language therapy, dietetic support, physiotherapy and other specialist rehabilitation alongside surgical follow-up.