Muscle, myocutaneous, or fasciocutaneous flap; head and neck (eg, temporalis, masseter muscle, sternocleidomastoid, levator scapulae)
CPT4 code
Name of the Procedure:
Muscle, myocutaneous, or fasciocutaneous flap; head and neck (e.g., temporalis, masseter muscle, sternocleidomastoid, levator scapulae)
Summary
This surgical procedure involves the use of muscle, skin, and sometimes underlying fascia tissue to reconstruct areas of the head and neck. It is often employed in cases where significant tissue is missing or damaged, such as after cancer resection or trauma.
Purpose
The procedure is performed to restore form and function to the head and neck region by transplanting healthy tissue to areas lacking sufficient tissue for proper healing. The main goals are to improve appearance, enable normal speech and swallowing, and protect vital structures.
Indications
- Large soft-tissue defects in the head and neck area
- Reconstruction after cancer surgery (e.g., after tumor removal)
- Traumatic injuries resulting in tissue loss
- Congenital defects or deformities requiring structural support
- Chronic wounds that haven't healed with simpler treatments
Preparation
- Pre-procedure fasting, typically 8 hours before surgery
- Adjustments to current medications as directed by the doctor
- Diagnostic tests such as blood work, imaging studies (e.g., CT or MRI), and physical examination
- Pre-operative consultations with surgeons, anesthesiologists, and possibly speech or physical therapists
Procedure Description
- Anesthesia: The patient is placed under general anesthesia.
- Incision and Flap Harvesting: An initial incision is made to harvest the flap, which includes the muscle, skin, and sometimes fascia.
- Transfer of Flap: The harvested tissue is carefully moved to the head or neck defect site.
- Attachment of Blood Supply: Microsurgical techniques are often used to connect the blood vessels of the flap to those at the recipient site.
- Securing the Flap: The flap is positioned and secured in place using sutures.
- Closure: The donor site and recipient site are then closed with sutures or staples.
Tools and equipment used include scalpels, surgical scissors, sutures, and microsurgical instruments for blood vessel connection.
Duration
The procedure can take anywhere from 4 to 12 hours, depending on the complexity and the specific requirements of the individual case.
Setting
This surgery is performed in a hospital setting, often in an advanced surgical suite equipped for microsurgery.
Personnel
- Primary Surgeon (typically a plastic or reconstructive surgeon)
- Assistant Surgeon(s)
- Anesthesiologist and nurse anesthetist
- Surgical Nurses
- Operating room technicians
Risks and Complications
- Infection at the donor or recipient site
- Blood clots or poor blood flow to the flap
- Flap failure or necrosis (tissue death)
- Scarring and cosmetic issues
- Nerve damage leading to loss of sensation or movement
- General anesthesia risks such as adverse reactions or complications
Benefits
- Restoration of appearance and structural integrity of the head and neck
- Improved speech, swallowing, and breathing functions
- Enhanced protection of vital structures, reducing the risk of further complications
- Faster and more effective healing of complex wounds
Recovery
- Hospital stay ranging from several days to a week for monitoring
- Pain management with medications
- Care of surgical sites, including regular dressing changes and hygiene
- Physical and speech therapy may be required
- Restrictions on physical activity for several weeks
- Follow-up appointments for wound checks and progress assessment
Alternatives
- Skin grafts: Suitable for smaller or less complex wounds but may not provide the functional benefits of a flap.
- Local tissue rearrangement: Moving tissues adjacent to the defect, suitable for smaller defects.
- Prosthetic replacements: Used mainly for structural support or cosmetic purposes.
- Each alternative has its own set of pros and cons, including healing time, cosmetic outcome, and functional restoration.
Patient Experience
- During the procedure, the patient will be under general anesthesia and will not feel any pain.
- Post-operatively, discomfort and swelling are common, managed with pain relievers.
- The patient may experience restricted movement and will need to adhere to care instructions.
- Recovery can take several weeks to months, with ongoing assessment to ensure proper healing of the flap and donor site.