15733 Muscle, myocutaneous, or fasciocutaneous flap; head and neck with named vascular pedicle (ie, buccinators, genioglossus, temporalis, masseter, sternocleidomastoid, levator scapulae)

Name of the Procedure:

Muscle, myocutaneous, or fasciocutaneous flap with named vascular pedicle for the head and neck.

Summary

This surgical procedure involves transferring a piece of muscle, skin, or fascia with its blood supply intact to the head or neck area to reconstruct or repair tissues. It uses specific muscles such as the buccinator, genioglossus, temporalis, masseter, sternocleidomastoid, or levator scapulae.

Purpose

The procedure primarily addresses defects or injuries in the head and neck region, such as those caused by trauma, cancer resections, or congenital anomalies. The goal is to restore functionality and aesthetics by providing well-vascularized tissue to the affected area.

Indications

• Large head and neck defects from cancer surgery
• Traumatic injuries needing complex reconstruction
• Reconstructive needs after significant congenital anomalies
• Soft tissue loss requiring robust vascularized tissue

Preparation

• The patient may need to fast for at least 8 hours before the procedure.
• Medications may need to be adjusted, especially blood thinners.
• Preoperative imaging and assessments (e.g., MRI, CT scans) are often required to plan the surgery.

Procedure Description

1. The patient is administered general anesthesia.
2. The surgeon identifies and prepares the donor muscle, skin, or fascia with its associated blood vessels.
3. The chosen flap is meticulously detached while preserving the vascular pedicle.
4. The flap is repositioned and attached to the recipient site in the head or neck.
5. Microsurgical techniques are used to connect blood vessels, ensuring proper blood flow.
6. The area is sutured, and a drainage system may be placed to prevent fluid buildup.

Duration

The procedure typically takes 4 to 8 hours, depending on the complexity and size of the flap.

Setting

The surgery is performed in a hospital operating room.

Personnel

• Surgeons with expertise in reconstructive or plastic surgery
• Anesthesiologists
• Surgical nurses
• Microsurgery specialists, if required

Risks and Complications

• Infection at the surgical site
• Bleeding and hematoma formation
• Flap failure due to poor blood supply
• Nerve damage
• Scarring and aesthetic irregularities

Benefits

• Effective restoration of functionality and appearance in the head and neck area
• Improved wound healing due to the well-vascularized tissue
• Enhanced quality of life by addressing both cosmetic and functional deficits

Recovery

• Patients typically stay in the hospital for several days post-surgery.
• Close monitoring of the flap for proper blood flow is crucial.
• Pain management involves medications, and antibiotics may be given to prevent infection.
• Physical activity may be limited for several weeks.
• Follow-up appointments are necessary to assess healing and function.

Alternatives

• Skin grafts: Less vascularized and thus may be less effective in some cases.
• Prosthetic devices: Can restore appearance but not function.
• Local tissue rearrangement: Suitable for smaller defects but not extensive ones.

Patient Experience

Patients may experience discomfort and swelling in the surgical areas. Pain management strategies include prescribed pain relievers. Over time, discomfort typically improves, and patients can expect to notice significant improvements in both function and appearance a few weeks to months after the procedure.