The face and neck are central to human interaction and vital physiological functions. When disease, trauma, or congenital conditions compromise these areas, the impact extends far beyond aesthetics; it affects the fundamental ability to breathe, speak, swallow, and eat. For patients facing significant tissue loss due to cancer resection or severe injury, standard wound closure is often insufficient. In these complex cases, Head & Neck Surgical Associates (HNSA) employs advanced microvascular reconstruction to restore both the form and function of the head and neck anatomy.
This sophisticated surgical subspecialty requires a high level of technical precision and physiological understanding. By transplanting tissue from one part of the body to another and reconnecting the blood supply under a microscope, the surgeons at HNSA can rebuild complex defects, offering patients a pathway to rehabilitation and a return to their daily lives.
Understanding Microvascular Reconstructive Surgery
Microvascular reconstruction, often referred to as “free flap” surgery, is the gold standard for repairing large defects in the head and neck region. Unlike a simple skin graft, which relies on the wound bed for blood supply, a free flap involves the transfer of “composite” tissue—which may include skin, muscle, bone, and nerves—along with its own dedicated artery and vein.
The procedure is technically demanding. Surgeons must identify a donor site on the patient’s body, harvest the necessary tissue, and carefully dissect the blood vessels supplying it. Once the tissue is transferred to the head or neck, the surgeon uses an operating microscope to suture the tiny blood vessels of the flap to recipient vessels in the neck. This process, known as anastomosis, re-establishes immediate blood flow to the transplanted tissue, ensuring its survival. This technique allows medical specialists to reconstruct substantial deficits in the jaw, tongue, throat, and face that would otherwise be impossible to repair.
Restoring the Mandible and Maxilla
One of the most critical applications of microvascular surgery is the reconstruction of the jawbones—the mandible (lower jaw) and maxilla (upper jaw). Defects in these bones, often resulting from the removal of benign or malignant tumors, can severely impair a patient’s ability to chew and maintain proper facial structure.
The standard of care for restoring large segments of the jaw is the fibula free flap. In this procedure, a section of the fibula bone from the lower leg is harvested along with its blood supply. The fibula is uniquely suited for this purpose as it provides ample bone stock for jaw surgery reconstruction and is capable of supporting dental implants.
At HNSA, surgeons utilize virtual surgical planning (VSP) to enhance precision. Before the patient ever enters the operating room, high-resolution CT scans are used to create a digital 3D model of the patient’s skull. The surgical team plans the exact cuts and angles required to shape the straight leg bone into the curvature of a new jaw. This technology reduces operating time and improves the accuracy of the reconstruction.
Furthermore, the team at HNSA is at the forefront of the “Jaw in a Day” technique. This advanced approach allows for the removal of the tumor, reconstruction of the jaw with the fibula bone, and the placement of dental implants and prosthetic teeth all in a single surgery. This immediate reconstruction significantly reduces the time to dental rehabilitation, helping patients regain their smile and chewing function much sooner.
Soft Tissue Reconstruction for Speech and Swallowing
Tumors affecting the tongue, floor of the mouth, or throat (pharynx and larynx) present unique challenges. The primary goal in these areas is to maintain the mobility required for speech and the mechanism necessary to protect the airway during swallowing. Bone and soft tissue surgery in this context often involves the use of pliable tissues, such as the radial forearm free flap (from the arm) or the anterolateral thigh flap (from the leg).
These thin, pliable tissues can be shaped to recreate the lining of the mouth or to reconstruct a portion of the tongue. When sensory nerves are included in the flap and connected to nerves in the neck (neurorrhaphy), patients may even regain sensation in the reconstructed area, further improving functional outcomes such as swallowing and speech articulation.
The HNSA Multidisciplinary Approach
Complex reconstruction is rarely a solo endeavor. HNSA operates within a robust multidisciplinary framework, partnering with major health systems to provide comprehensive care. Through the clinics affiliated with Providence Cancer Center and Legacy Health, the surgeons collaborate with a wide team of specialists.
This team approach is vital for patients undergoing surgery for oral, head, and neck cancer. The reconstruction is planned in concert with medical oncologists, radiation oncologists, speech and language pathologists, nutritionists, and maxillofacial prosthodontists. This ensures that the surgical plan aligns with potential future treatments, such as radiation therapy, and prioritizes the patient’s long-term quality of life.
Fellowship-Trained Expertise
The complexity of microvascular surgery demands specialized training beyond standard residency. The surgeons at HNSA, including Dr. Allen Cheng, Dr. Ashish Patel, and Dr. Baber Khatib, have completed dedicated fellowships in Head and Neck Oncology and Microvascular Reconstructive Surgery. Their dual-degree background—holding both Medical Doctor (M.D.) and Doctor of Dental Surgery (D.D.S.) degrees—provides a comprehensive perspective on facial reconstruction.
This unique qualification is particularly advantageous in head and neck reconstruction. The dental background ensures a deep understanding of occlusion (how teeth bite together) and jaw function, while the medical and general surgery training provides the expertise required to manage complex systemic health issues and perform intricate vascular work. HNSA is also committed to training the next generation of surgeons through their own Head and Neck Fellowship program, ensuring that high standards of care continue to evolve.
Trauma and Secondary Correction
While cancer reconstruction comprises a significant portion of microvascular cases, these techniques are also essential for treating severe facial trauma. High-velocity injuries, such as those from motor vehicle accidents or ballistic trauma, can result in composite defects similar to those seen in oncologic resection. The HNSA team serves as a primary resource for trauma centers in the region, providing immediate and delayed reconstruction for complex facial injuries.
Additionally, microvascular surgery offers solutions for patients suffering from the late effects of previous trauma or radiation, such as osteoradionecrosis (bone death due to radiation). In these cases, introducing healthy, vascularized bone and tissue can heal chronic wounds and restore structural integrity.
Recovery and Rehabilitation
Undergoing microvascular reconstruction is a significant event in a patient’s life. The recovery process begins in the hospital, typically involving a stay in the Intensive Care Unit (ICU) for close monitoring of the flap’s blood circulation. The HNSA team monitors the transplanted tissue hourly during the initial postoperative period to ensure the blood vessels remain open and the tissue remains viable.
Rehabilitation is an active process. Speech and swallowing therapists work with patients shortly after surgery to retrain the muscles of the mouth and throat. For patients receiving jaw reconstruction, the journey may continue with the placement of dental implants and prosthetics once the bone has fully healed. The goal is always to help the patient return to a life that feels as normal as possible, with restored confidence in their appearance and abilities.
Scheduling a Consultation
Patients requiring advanced reconstruction often come to HNSA through a referral from an oncologist or trauma center. However, the practice also consults with patients seeking second opinions or secondary reconstruction for established defects. To discuss a case with the surgical team, patients or referring providers can request an appointment or contact the office directly.
Connect with the Head and Neck Institute
For those interested in the academic and philanthropic efforts of the practice, the Head and Neck Institute serves as the education and research arm of HNSA. Through the Institute, the surgeons advance the field of reconstructive surgery via research, publications, and the training of fellows and residents.
Stay connected with HNSA for the latest updates on patient success stories and advancements in surgical care by following the practice on Facebook and LinkedIn.
Head & Neck Surgical Associates is the Northwest’s most specialized surgical practice, uniquely staffed by dual-degreed, board-certified physicians trained in both medicine and dentistry. Based in Portland, Oregon, their team offers expert care in head and neck surgery, oral and maxillofacial procedures, and facial cosmetic surgery—backed by advanced fellowships and decades of focused experience. Patients trust HNSA for precise diagnoses, complex surgical treatment, and comprehensive care from true leaders in their field.
