Microvascular and Reconstructive Surgery

Overview

From its founding in 1995 by Dr. Keith Blackwell, the Microvascular and Reconstructive Surgery section has been at the forefront of surgical expertise. Surgeons within the Department of Head and Neck Surgery have an extensive experience with this state-of-the-art reconstructive surgical method, treating more patients than most, if not all, other medical centers in the United States. This is a technically demanding surgical technique in which tissue grafts harvested from the arms, legs, abdomen, and back are transferred to the mouth, throat, or face to replace missing tissues.

Patient Care

Candidates for this surgery include patients who suffer from the effects of cancers or tumors of the head and neck and their treatment, including the effects of radiation therapy. Patients with severe traumatic injuries of the face or neck may also be candidates for this type of reconstruction.

Treatment

Microvascular reconstructive surgery involves the transfer of autogenous vascularized tissue to reconstruct extensive tissue defects. Areas commonly reconstructed include the jaws and mouth, the throat, and all areas of the face, scalp, and neck. Depending on the recipient defect site created from either trauma and/or head and neck cancer, a plethora of possible donor sites are available for transplantation. These include the following:

radial forearm free flap
fibula free flap
latissimus dorsi free flap
anterolateral thigh free flap
subscapular free flaps: including scapula, parascapular, latissismus serratus rib free flaps
rectus free flap
iliac crest free flap
jejunal free flap

A successful outcome in this type of reconstructive surgery depends upon meticulous suturing of 2 to 3mm blood vessels using a microscope and sutures that are finer than human hair to re-establish blood flow to the tissue graft. Because of the technically demanding nature of this type of surgery, most medical centers report failure of this type of reconstruction in 5 to 10 percent of cases. The UCLA Department of Head and Neck Surgery has achieved a success rate that exceeds 99 percent in performing approximately 1,300 cases of microvascular reconstructive surgery during the 15 years since this program was established, and our institutional success rate currently equals or exceeds that reported by all other medical centers in the world.