Microvascular Reconstruction

Microvascular reconstruction is a highly specialized surgical technique used to restore complex defects in the head and neck region resulting from trauma, cancer resection, or other causes. This advanced procedure involves the transfer of tissue—such as skin, muscle, bone, or a combination thereof—from one site in the body to another. What distinguishes microvascular reconstruction from other reconstructive methods is the meticulous anastomosis (connection) of tiny blood vessels from the transplanted tissue flap to recipient vessels in the head and neck, performed under high-powered magnification.

What is Microvascular Reconstruction?

Following trauma or oncologic surgery, patients may be left with significant defects that impair function, appearance, or both. Microvascular reconstruction enables the transplantation of well-vascularized tissue to fill these complex defects, promoting optimal healing and restoring vital functions such as speech, swallowing, breathing, and facial movement.

The procedure requires:

Harvesting tissue flaps (free flaps) from donor sites like the forearm, thigh, or fibula,
Careful dissection and preservation of small arteries and veins,
Connecting donor vessels to recipient vessels using microsurgical techniques.

This blood supply restoration is crucial for flap survival and long-term success of the reconstruction.

Indications for Microvascular Reconstruction

Microvascular free tissue transfer is indicated in cases such as:

Extensive head and neck cancer defects after tumor removal (e.g., oral cavity, mandible, tongue, oropharynx),
Complex traumatic injuries involving soft tissue, bone, or composite structures,
Radiation-induced tissue damage requiring robust vascularized tissue for repair,
Failed or insufficient prior reconstructions.

Benefits of Microvascular Reconstruction

Restores Complex Anatomy: Allows simultaneous reconstruction of multiple tissue types (skin, muscle, bone),
Improves Functionality: Supports breathing, swallowing, speech, and facial expressions,
Enhances Aesthetic Outcomes: Customizable tissue selection and shaping,
Reduces Morbidity: Enables use of tissues distant from injured sites, preserving local structures,
Promotes Healing: Well-vascularized flaps are more resistant to infection and radiation damage.

Dr. Tang Ho’s Expertise

At the Texas Center for Facial Plastic Surgery, Dr. Tang Ho brings extensive expertise in microvascular reconstruction, having performed thousands of successful free flap surgeries. His advanced training and experience enable him to manage the most challenging head and neck defects with precision, maximizing both functional and cosmetic outcomes.

The Microvascular Reconstruction Procedure

Preoperative Planning: Comprehensive evaluation of the defect, imaging studies to identify suitable recipient vessels, and donor site assessment.
Tissue Harvesting: Microsurgical dissection of donor tissue with its blood supply.
Defect Preparation: Removal of diseased or damaged tissue.
Microsurgical Anastomosis: Connection of donor and recipient vessels using microsutures under high-magnification operating microscopes.
Insetting and Shaping: Precise placement and contouring of the flap to restore facial form.
Postoperative Care: Close monitoring of flap viability, management of pain, and rehabilitation.

Recovery and Outcomes

Recovery varies based on the extent of surgery and patient health. Hospital stay typically ranges from 5 to 10 days with careful monitoring in specialized units. Most patients regain significant functional abilities within weeks to months, supported by multidisciplinary care including speech and physical therapy.

Conclusion

Microvascular reconstruction represents the pinnacle of modern reconstructive surgery, offering hope and restoration to patients facing complex head and neck defects. Through meticulous technique and personalized care, Dr. Tang Ho and his team strive to restore not only appearance but also quality of life.

Frequently Asked Questions (FAQs) About Microvascular Reconstruction

Q: What types of tissue can be transferred in microvascular reconstruction?

A: Microvascular reconstruction can involve transferring various types of tissue including skin, muscle, bone, fat, or a combination (composite tissue flaps). The choice depends on the specific defect being reconstructed.

Q: How long does a microvascular reconstruction surgery typically take?

A: These surgeries are often lengthy, ranging from 6 to 12 hours or more, depending on the complexity of the defect and the type of tissue transferred.

Q: What makes microvascular reconstruction different from other reconstructive techniques?

A: The key difference is the microsurgical connection (anastomosis) of blood vessels from the transplanted tissue to vessels in the head and neck, ensuring the transferred tissue receives its own blood supply and survives.

Q: Is microvascular reconstruction safe?

A: Yes, when performed by experienced microsurgeons like Dr. Tang Ho, microvascular reconstruction is generally safe. Risks include flap failure, infection, or bleeding but are minimized with expert surgical technique and close postoperative monitoring.

Q: How long is the recovery period after microvascular reconstruction?

A: Hospital stays usually range from 5-10 days. Full functional recovery may take weeks to months and often involves physical therapy, speech therapy, or other rehabilitative services.

Q: Will microvascular reconstruction restore normal appearance and function?

A: While results vary based on the defect’s severity, microvascular reconstruction aims to restore both aesthetic form and essential functions such as speech, swallowing, and facial movement to the greatest extent possible.

Q: What are common donor sites for free tissue flaps?

A: Common donor sites include the radial forearm, fibula (lower leg bone), anterolateral thigh, and latissimus dorsi (back muscle), among others.

Q: Can microvascular reconstruction be performed after radiation therapy?

A: Yes, microvascular free flaps provide well-vascularized tissue that helps heal radiation-damaged areas, making reconstruction possible even after radiation therapy.

Q: How is flap viability monitored after surgery?

A: Flap viability is assessed frequently using clinical examination, Doppler ultrasound, and sometimes advanced technologies to ensure adequate blood flow and to detect any issues early.

Q: Will I have scars or donor site wounds?

A: Yes, surgical scars are present at both the recipient and donor sites. Our surgical team places incisions meticulously to minimize their visibility, and donor site wounds usually heal well with appropriate care.

Contact Us

For consultations or more information about microvascular reconstruction, please contact the Texas Center for Facial Plastic Surgery. Our multidisciplinary approach ensures comprehensive care throughout your treatment journey.