Free Flap Surgery

In free flap surgery, your providers will move skin, soft tissue and/or bone and its blood supply (arteries and veins) from one part of your body to the area that needs to be reconstructed. It may contain skin, bone, soft tissue, muscle, nerves and fat, depending on what needs to be done to restore how your face looks and works.

As we decide where on your body to take the flap, we’ll look for areas that have a good blood supply — and where you’ll have few, if any, long-term effects. These could be from your arm, leg, abdomen (belly), chest or upper back. Since recovery from upper thigh surgery is typically easier, our surgeons specialize in using complex anterolateral thigh (ALT) flap surgery for most conditions of the head and neck. We use this donor site if possible, since recovery is quicker when tissue is taken from this area.

Why consider free flap surgery

Our surgeons routinely use free flap surgery for:

• Facial trauma: During facial trauma reconstruction, we rebuild areas of your nose, forehead, eye sockets, ears, cheeks, mouth or jaw damaged by severe burns, injury or surgery. Our surgeons have pioneered new methods in total nasal reconstruction combining thigh flaps, bone and cartilage and facial skin flaps.
• Osteoradionecrosis: Free flap transfer for osteoradionecrosis can improve blood supply to the damaged tissue in your head, neck or jaw after radiation therapy. When we do the surgery before full thickness bone damage occurs, we may not have to do a full jaw resection and reconstruction. So surgery may be shorter and you won’t have to stay in the hospital as long.
• Head and neck reconstruction following tumor resection: We reconstruct wounds after surgery to remove benign (noncancerous) or malignant (cancerous) tumors from your head and neck. Our surgeons specialize in complex palate, midface, eye and nasal reconstruction and restoring how your face looks and moves after parotid surgery.

The results of free flap surgery are often better than other reconstructive options, like skin grafts or skin or muscle flaps. This is because we can cover large or deeply damaged areas and keep your tissue healthy and elastic. You’ll also have a lower risk of complications and often a shorter hospital stay.

If you’re having surgery to remove a tumor from your jaw or another part of your head or neck, we can do free flap reconstruction at the same time as that surgery. But we can also wait until after your surgery — even years later. It’s up to you.

What to expect at your consultation

Testing before surgery helps us see how healthy your arteries and veins are. It’s important to have good circulation in the areas where we take the flap and where we move it. These tests may include:

• Allen test, which is a physical exam that lets us see how the blood flows in your hands and forearms.
• Angiogram, which shows us how blood flows throughout your body.
• Vascular ultrasound, which gives us a closer look at your veins and blood vessels.

Other tests you might have include a CT scan and MRI of your head and neck. These imaging tests give us detailed pictures of the bone and soft tissues that need repair. They also help us look at the quality of the blood vessels which the flaps will be attached to.

Meet Our Free Flap Surgery Team

When you choose Cleveland Clinic for free flap surgery, you’ll have a team of healthcare providers in different specialties working together to plan your treatment so you get the best possible results. Depending on your needs, your care team could include:

• Head and neck oncologic surgeons.
• Facial plastic and reconstructive surgeons.
• Oncologists.
• Physical therapists.
• Occupational therapists.
• Speech therapists.
• Neurosurgeons.
• Skull-based surgeons (rhinologists and otologists).
• Dermatologic (skin) surgeons.
• Neurologists.
• Infectious disease.

Your care team will let you know what to expect before surgery. They’ll answer your questions and listen to your concerns. 

Before the procedure, your provider will give you general anesthesia, so you’ll be asleep during surgery, and you won’t feel any pain.

When we start surgery, your providers will take the flap and blood vessels to be moved in the least invasive way possible. They’ll also remove damaged tissue and bone from the area that needs reconstruction.

After making sure the flap tissue has healthy nerves and blood vessels, they’ll carefully move the flap to the area that needs reconstruction. Then, they’ll use a special microscope and surgical tools to attach the flap’s blood vessels to the ones in the new area — creating a new blood supply.

Once we place the flap and get blood flowing to it, we’ll work on the bone and soft tissue so they can replace missing parts in your face. Our goal is to make the flap look and feel like your original neck, head or face tissue.  To get the best results, we may have to do several surgeries — spaced apart — so the tissue can heal and settle.

Recovering from surgery

You’ll usually stay in the hospital for a few days to a week after surgery. Before you leave the hospital, you’ll learn how to care for your surgical wounds and any remaining drains that remove excess blood and fluids. These drains will stay in place for about a week.

If your surgery was in your mouth, you’ll be on a liquid diet at the hospital (either right away or after a few days, depending on the extent of surgery), and then you’ll need to eat only soft things that don’t need much chewing for up to six weeks.

As you heal, you might also do physical therapy to regain strength in the areas where you had surgery. We’ll also make sure we schedule follow-up appointments with your care team to check on your recovery.

Taking the Next Step

Reconstructive surgery can profoundly affect your life — physically and emotionally. Our highly skilled surgeons are experts in free flap surgery. This experience makes us uniquely qualified to treat the most complex, challenging head, jaw, neck and facial reconstruction conditions. Even if you’ve been told you’re out of treatment options, we’re here to help. You’ll get the compassionate, supportive care you deserve throughout your treatment process.