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Facial and head and neck reconstruction

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Chris Dunkin is our Consultant Plastic Surgeon at Tees Plastic Surgery. His NHS post is in the Department of Reconstructive Plastic Surgery at the James Cook University Hospital in Middlesborough where he specialises in reconstructive surgery.

He is a member of the Head and Neck Cancer Multidisiplinary Team (MDT) which provides a service to the population of Teesside and the Tees Valley, North Yorkshire and South Durham and from other parts of the UK. 

>> Book a consultation with our Consultant Plastic Surgeon.


What is facial, head and neck reconstruction?

Treatment for head and neck cancer usually involves surgery, radiotherapy or a combination of the two. In some cases reconstruction is required after the cancer has been removed. Some wounds can be closed simply with stitches. More complex defects require flap cover. A flap is a piece of health body tissue (skin, muscle, bone or a combination of these tissues) used to replace what has been removed and rebuild the face or neck.


How do we reconstruct the face, head and neck? 

Microvascular reconstruction – free tissue transfer or free flap surgery revolutionised head and neck surgery in the 1980s and was brought to our region in the late 1990s. Since then it has become a routine part of head and neck surgery. In free flap surgery a piece of tissue is transplanted form one part of the body to another.

Early on the radial forearm was the workhorse flap for head and neck reconstruction. This involves removal of a piece of skin from the wrist/forearm with its blood supply (radial artery and veins) and transfer to the head and neck defect. The radial artery and vein are then joined to blood vessels in the neck using an operating microscope (microanastomosis) and the patch of skin is stitches into the close the defect. Over the last decade this has been  largely superseded by other alternatives, including the anterolateral thigh flap (ALT).

The main flaps used for head and neck reconstruction are:

Anterolateral thigh flap (ALT)
Radial and ulnar forearm flaps (RFF and UFF)
Rectus abdominis flap (RA)
Latissimus dorsi flap (LD)
Fibula flap
Jejunum flap

Perforator flaps – popularised in plastic surgery more generally over the last 10 years, perforator flaps are based upon specific small blood vessels (arterial perforators) that are mapped before surgery with a Doppler ultrasound device. 

Supraclavicular artery perforator flap (SCAP)
Submental artery perforator flap (SMAP)
Intercostal artery perforator flaps (ICAP)

Regional flaps – involve taking tissue from the same area of the body and moving it round to reconstruct
the defect and were the only option before free flaps

Pectoralis major flap – the old-fashioned stalwart of head and neck reconstruction
still has a place in modern practice, usually as a back up plan
Deltopectoral flap – one of the first regional flaps described for head and neck reconstruction, 
the DP flap is rarely used nowadays 
Temporalis muscle and fascial flaps – can be very useful for defects around the ear, eye and cheek. More recently repopularised for facial plasy treatment
Latissimus dorsi and Trapezius flaps may be used as a secondary option if primary flaps are unavailable or unsuccessful. Local flaps – these involve taking skin from adjacent to the defect and are useful for small defects after skin cancer removal. 

 


What else do we offer? 

Melanoma and non-melanoma skin cancer treatment.
Neck dissection (removing the chain of lymph glands of the neck when a skin cancer has spread).
Reconstruction (rebuilding).
Parotid surgery – management of benign and malignant tumours of the parotid gland.
Eyelid and periorbital surgery (occuloplastic surgery).
Eyelid and periorbital  tumour resection and reconstruction.
Fat transfer (lipofilling or autologous fat grafting) – uses fat harvested form one part of the body
to treat contour defects in the head and neck, such as temporal hollowing after neurosurgery.
Facial palsy (facial paralysis or facial weakness) – Mr Dunkin provides a comprehensive service
for the management of patients with facial palsy <insert hyperlink to facial palsy page.


Where do I get further information? 

BAPRAS

Macmillan Cancer Care 


How do I make an appointment to see you? 

You can make an appointment yourself if you wish to be seen privately on 0844 272 5951 or click on the link below to email us. 

>> Book a consultation with our Consultant Plastic Surgeon.

For NHS referrals please ask your General Practitioner or hospital specialists to refer you directly to us at the Department of Plastic Surgery at the James Cook University Hospital or via the Choose-and-Book system.

 


Paying for treatment

Tees Plastic Surgery offers Consultant-delivered state-of-the-art cosmetic surgery procedures at the Nuffield Health Tees Hospital Stockton-on-Tees and BMI Woodlands Hospital Darlington. Paying for your treatment could not be simpler and both Nuffield Health and BMI hospitals offer loans to fund surgical treatment.

>> Please click here for more information


What do I do now?

Our clinic is based at the Nuffield Health Tees Hospital Stockton-on-Tees and BMI Woodlands Hospital Darlington.

Please contact us on 0844 272 5951 for a consultation 
or click on the link below to email us.

>> click here to email us to book a consultation.

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