Reconstructive surgery for mouth and oropharyngeal cancer

When the surgeon removes a large area of tissue in your mouth or oropharynx, they rebuild (reconstruct) the area. This is called reconstructive surgery.

You can have reconstruction surgery using:

• tissue from another part of the body (a flap)
• skin from another part of the body (a skin graft)
• bone from another part of the body

Your surgeon might need to remove a lot of tissue when you have surgery for mouth and oropharyngeal cancer. 

Reconstructive surgery can reduce the effect that surgery has on:

• bodily functions such as eating, breathing or talking
• the way you look (appearance)

You might have a temporary hole (tracheostomy) in your neck to help you breathe after your surgery. The hole is also called a stoma.

Using skin from another part of the body

A skin graft

A skin graft is a thin sheet of skin that your surgeon removes from another part of your body (donor site). They use it to cover the area of skin they remove. The donor site usually comes from somewhere not too obvious, such as your inner thigh.

How you have it

You have a skin graft during the operation to remove your cancer. The surgeon shaves off the sheet of skin (using a special instrument) or cuts out the donor site. You have a dressing on the donor site.

You don't usually need stitches if your surgeon shaves the donor site. It will heal on its own. You have stitches to repair a donor site that has been cut away.

The skin graft is very delicate while it heals. It's very important that it is not damaged or knocked while healing. Your doctor and nurses will be very careful that your wound doesn't become infected. You may have antibiotics to prevent this.

A disadvantage of skin grafting is sometimes the skin looks different from the surrounding area. For example, it may be a slightly different colour and appear as a dent compared to the surrounding skin.

Using tissue from another part of the body

Flap repair 

An operation that moves tissue from one part of the body to another is called a reconstruction free flap or flap repair.  

Your surgeon might take tissue from an area such as the bowel or the muscles in the arms, back or tummy, and use this to replace sections of the mouth or throat. 

Your surgeon may use micro vascular techniques to sew together small blood vessels under a microscope. This is a specialised surgery (by a maxillofacial surgeon). 

After surgery your nurses keep a close eye on the flap. They make sure the new tissue is getting a good blood supply to bring oxygen and nutrients.

Using bone from another part of the body

Sometimes your surgeon may need to remove part of your jawbone. They may replace it using bone taken from the hip or lower leg. 

They usually use the bone together with some of its blood vessels. Once the bone is in place, they secure it with metal surgical screws. 

Dental implants 

You may need dental implants to replace any teeth removed during surgery. This may be at the same time as your surgery or at a later date. 

Coping

A reconstruction can change your appearance and cancer treatment can change how you feel. You may have emotional ups and downs after your surgery. Many people find it helpful to talk about their feelings and ask about things that worry them.

The team looking after you will prepare you as much as they can before your surgery by explaining what to expect and how to cope.

Your specialist head and neck nurse is a good source of support for you and your family. They can talk you through a lot of worries and put your mind at rest. 

Possible problems after reconstructive surgery

There is a risk of problems or complications after any operation. Many problems are minor but some can be life threatening. Treating them as soon as possible is important.

Infections

You are at risk of getting an infection after surgery, such as a wound or chest infection. Tell your doctor or nurse if you have any symptoms of infection.

They include:

• a high temperature
• shivering
• feeling hot and cold
• feeling generally unwell
• redness around either wound site (the donor site or the site of the reconstruction)
• fluid seeping from the wound (discharge)
• a cough

Contact your 24 hour advice line immediately if you have any of these symptoms and think you might have an infection.

Numbness

The area around the donor site and the reconstructed area may feel numb after surgery. This usually improves over a few months, but for some people, it may not completely get better.

Flap failure

Rarely one of the blood vessels can become blocked with a clot. This means the flap doesn’t get a blood supply. This usually happens within the first 48 hours after surgery. If this happens, you will need to go back to the operating theatre to try to save the flap. Sometimes the flap cannot be saved and the surgeon has to remove it.  

You can usually have another reconstruction later date.