Reconstruction Surgeries: Pedicles or Free Flaps for Cancer Surgery Defects

Being diagnosed with cancer and then going through its treatment is an overwhelming process for anyone. Many people undergo cancer or tumour removal surgeries to get rid of them. While these types of surgeries are important, they may leave certain deformities in the appearance of the patient. This, in turn, affects the self-esteem and confidence of a cancer survivor.

Reconstruction after cancer removal refers to the process of restoring the appearance and function of a body part that has been affected by cancer surgery. This can include reconstructive procedures such as breast reconstruction after mastectomy, facial reconstruction after the removal of skin cancer, or limb reconstruction after the removal of bone cancer.

Reconstruction Surgeries at Apollo Hospitals, Karnataka

We understand that Reconstruction Surgeries after cancer removal are important to help patients get back to their normal lives confidently with no body image issues.

Cancer surgery often involves the removal of tumours that leave behind defects that require reconstruction. Pedicle flaps and free flaps are two commonly used techniques for reconstructing these defects. At Apollo Hospitals Karnataka, a team of highly skilled and experienced surgeons evaluates each patient’s case individually to determine the best approach for their specific needs.

Pedicle Flaps

A pedicle flap is a surgical technique used in reconstructive surgery to move tissue from one part of the body to another while keeping it attached to its original blood supply. This allows the tissue to maintain its blood flow and survive in its new location. Pedicle flaps are ideal for small to moderate-sized defects. These are mostly used in breast reconstructive surgeries.

Free Flaps

Free flaps are a type of surgical technique used in reconstructive surgery in which a section of tissue is completely detached from its original blood supply and relocated to a new location where it is reconnected to a different blood supply. This relocation often involves a significant distance between the donor and recipient areas.

Ultimately, the choice between these techniques depends on various factors, including the size and location of the defect, the patient’s medical history, and the surgeon’s expertise. Doctors at Apollo Hospitals, Karnataka, will carefully evaluate every case to determine whether Pedicles or Free Flaps is the ideal choice for reconstruction.

Before Procedure

Before going for reconstruction surgery, our surgeons go through below steps:

1. Evaluations: Patients will go through a thorough evaluation to assess their medical history and current health status. Doctors at Apollo Hospitals, Karnataka, will ensure that they perform all the critical physical examinations, imaging tests, and laboratory tests.
2. Consultations: We will schedule consultations before the surgery to discuss surgery goals, risks, and benefits with the patient.
3. Planning for the Surgery: Based on the patient’s case, our surgeons will develop a personalised treatment plan. Surgeons will decide what type of reconstructive procedure will be performed i.e. Pedicles or Free flaps.
4. Pre-preparation: Before the surgery, patients may need additional treatments such as radiation therapy or chemotherapy.

Our doctors will also provide detailed instructions on how to prepare for the surgery, including guidelines for eating and drinking before the procedure, medications to avoid, and other preoperative measures.

During Procedure

What happens during a reconstructive procedure will largely depend on the choice of procedure by the doctors. Both procedures typically use general anaesthesia.

Pedicle Flap Procedure:

1. Donor site selection: The surgeon identifies the donor site from which the flap will be taken. The donor site is typically located near the area that requires reconstruction, and the choice of site will depend on the size and shape of the defect being addressed.
2. Flap creation: The process of flap creation requires the surgeon to carefully cut around a section of tissue, preserving its blood supply through a small pedicle or stalk before transferring it to another area of the body.
3. Flap transfer: The flap is then carefully moved to the recipient site and secured in place. The pedicle remains attached to the donor site, providing a continuous blood supply to the flap until new blood vessels grow in the recipient site.
4. Flap shaping: Once the flap is in place, the surgeon may shape it further to ensure that it matches the surrounding tissue and provides optimal defect coverage.

1. Closure: The donor and recipient sites are closed with sutures or staples, and the patient is monitored in the recovery room before being moved to a hospital room for further recovery.

Free Flap Procedure

• Donor site selection: The surgeon identifies the donor site from which the flap will be taken. The donor site is typically located away from the area that requires reconstruction, and the choice of site will depend on the size and shape of the defect being addressed.
• Flap creation: The surgeon creates the flap by carefully cutting around it, disconnecting it completely from its original blood supply. The flap is then moved significantly to be reconnected to a new blood supply at the recipient site.
• Blood vessel connection: The surgeon then uses microsurgical techniques to connect the blood vessels of the flap to those of the recipient site, ensuring that the flap has a steady supply of blood.
• Flap shaping: Once the flap is in place, the surgeon may shape it further to ensure that it matches the surrounding tissue and provides optimal defect coverage.
• Closure: The donor and recipient sites are closed with sutures or staples, and the patient is monitored in the recovery room before being moved to a hospital room for further recovery.

After Procedure

After the reconstructive surgery is done, the following steps will take place:

1. After the surgery, the patient is moved to the recovery room, where they will be closely monitored by medical staff.
2. Patients undergoing pedicle or free flap surgery will usually be required to stay in the hospital for several days to a week or more. During this time, they will receive pain management and other medications, and medical staff will monitor the flap’s blood flow and overall healing.
3. Once the patient is cleared to begin moving, physical therapy is usually advised to help promote healing, restore mobility, and prevent complications such as blood clots.
4. We will schedule regular follow-up appointments with the patient to monitor the healing process and ensure that the flap is functioning properly. In some cases, additional surgeries or treatments may be needed to address complications or refine the results of the initial surgery.

Overall, the recovery process following pedicle or free flap surgery can be lengthy and challenging, but with proper care and monitoring, most patients can make a full recovery and enjoy improved function and quality of life.

Complications & Risks

Being a medical procedure, reconstructive surgery does pose a risk of complications. Some complications that may occur include:

1. Bleeding
2. Blood clots
3. Bruising
4. Flap dissection errors
5. Flap failure
6. Infection
7. Nerve damage
8. Skin necrosis
9. Swelling

Who is not Eligible?

 The following types of patients may not be eligible for reconstructive surgery:

1. Patients with active infections
2. Patients with ongoing medical conditions like cancer
3. Patients who have unrealistic expectations from the surgery
4. Patients with poor blood supply

Reconstructive surgery is different for every patient. That is why doctors at Apollo Hospitals Karnataka, evaluate and screen each patient carefully to ensure they are eligible for the procedure.

Treatment at Apollo Hospitals Karnataka

Apollo Hospitals Karnataka is committed to providing the best possible care for patients requiring reconstruction surgeries such as pedicles or free flaps for cancer surgery defects. With highly trained and experienced surgeons, state-of-the-art facilities, and a patient-centred approach, we strive to achieve optimal outcomes for our patients, help them regain their self-esteem and boost their quality of life.