Head and neck cancer reconstruction surgery rebuilds the tongue, jaw, palate, throat or facial skin removed with a tumor, in the same operation, so that patients can swallow, speak and breathe again. Most large defects use a free flap from the forearm, thigh or fibula, with 3D virtual planning for jaw reconstruction and dental implants. At Biruni Hospital in Istanbul, our head and neck and microsurgery teams plan surgery and radiotherapy together.
About This Department
Plastic Surgery
Removing a head and neck cancer can take part of the tongue, jaw, palate or throat. Reconstruction rebuilds them in the same operation.
Head and neck cancer reconstruction surgery restores the tissue removed with a tumor of the mouth, jaw, throat, larynx, sinuses or facial skin, so that the patient can swallow, speak, breathe and look recognizably like themselves. Most large defects are rebuilt with a free flap, skin, muscle or bone moved from the forearm, thigh, lower leg or shoulder blade with its own artery and vein, which are joined to vessels in the neck under the microscope. In a meta-analysis, 3.8 percent of free flaps failed completely, a rate comparable with high-income centers (de Berker and colleagues, Journal of Plastic, Reconstructive and Aesthetic Surgery, 2022). Three-dimensional virtual planning shapes a fibula bone flap to match the jaw before surgery, and dental implants placed at the time of reconstruction survived in 92.5 percent of cases in a meta-analysis of oral cancer patients (Dugast and colleagues, Head and Neck, 2025). This page explains the options from local to free flaps, reconstruction by site, virtual planning, teeth, radiotherapy, risks, the hospital stay, rehabilitation, and how patients from abroad arrange reconstruction at Biruni Hospital in Istanbul.
96
Percent of free flaps surviving in a meta-analysis, with total failure in 3.8 percent
92.5
Percent survival of dental implants placed in the bone flap at the time of reconstruction
73.8
Minutes of flap ischemia with virtual surgical planning, against 109.9 with free-hand shaping
Free
Review of your scans and pathology by our head and neck team
The cancer surgeon removes the tumor with a margin of healthy tissue. The reconstructive surgeon rebuilds what was removed, in the same anesthetic.
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Immediate reconstruction
Rebuilding at the same operation protects the major blood vessels of the neck, closes the mouth and throat watertight, allows radiotherapy to start on time and spares a second major operation.
The aim reaches beyond closing the wound. A rebuilt tongue should move, a rebuilt jaw should hold teeth, and a rebuilt throat should carry food without leaking.
Function before form
Appearance matters. Function matters more.
People judge a face first, but daily life after head and neck cancer turns on eating a meal without coughing, speaking clearly enough to work and to use the telephone, breathing without a tube and keeping saliva inside the mouth, so the reconstructive plan starts from those functions and then shapes the tissue to restore the contour of the jaw, cheek and lips as closely as possible.
Each choice involves a trade-off. We explain them before surgery.
From simple closure to free flaps
Options for closing a head and neck defect
Option
Suited to
Limitation
Direct closure
Small defects
Tethering of tongue or lip
Skin graft
Shallow surface defects
Contracts, no bulk
Local flap
Small to medium defects nearby
Limited tissue
Pedicled flap, such as pectoralis major or submental
Medium defects, salvage
Bulk, reach and arc of rotation
Free flap
Large or complex defects, bone
Microsurgery, longer operation
Choosing the simplest option that restores function is the rule. For many defects of the tongue, floor of mouth, jaw and throat, that option is a free flap.
Why free flaps
A free flap brings the right type of tissue, thin and pliable skin for the tongue, solid bone for the jaw, a tube for the throat, from a distant site with its own blood supply. Because it lives on its own vessels, it heals well even in tissue that will receive radiotherapy.
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Microsurgery
The flap artery and vein are joined to neck vessels under an operating microscope.
Pedicled flaps still matter. They suit patients who cannot tolerate a long operation and serve as a backup if a free flap fails.
Reconstruction by site
Every part of the head and neck has its own function, and the reconstruction follows it.
Bone is replaced with bone, lining with thin skin, and bulk with muscle or fat, so that the rebuilt area behaves like the original.
Matching tissue to the defect
Typical reconstruction by site
Site removed
Common reconstruction
Goal
Part of the tongue or floor of mouth
Radial forearm or thigh free flap
Mobility for speech and swallowing
Lower jaw, mandible
Fibula bone free flap
Jaw contour, bite, teeth
Upper jaw and palate, maxilla
Fibula or scapula flap, or obturator
Separate mouth from nose, support cheek
Throat, pharynx, after laryngectomy
Thigh flap tubed, or jejunum
Swallowing route
Cheek, lip, scalp skin
Local or free flap
Cover and contour
Facial nerve
Nerve graft or transfer
Facial movement
Common free flaps
Donor sites
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Choosing the donor
Each donor site leaves its own scar and effect, and we choose the one that supplies the right tissue with the least lasting effect for the patient.
Workhorse free flaps in head and neck reconstruction
Flap
Tissue
Donor site effect
Radial forearm
Thin, pliable skin
Forearm scar, skin graft
Anterolateral thigh
Skin, fat, muscle in varied bulk
Thigh scar, minimal weakness
Fibula
Bone up to 25 centimeters with skin
Leg scar, ankle stable
Scapula
Bone and skin from the back
Back scar, shoulder recovers
Latissimus dorsi
Large muscle
Back scar
Blood vessels in the leg are checked with a scan before a fibula flap, so that the foot keeps a good blood supply.
Three-dimensional planning
Virtual surgical planning compared with free-hand shaping, meta-analysis
Measure
Virtual planning
Free hand
Change in jaw angle
3.6 degrees
7.7 degrees
Flap ischemia time
73.8 minutes
109.9 minutes
Total operative time
391.8 minutes
457.6 minutes
From a CT scan of the jaw and the leg, engineers and surgeons plan the bone cuts on a computer, then print cutting guides and often a custom plate. The fibula is cut and shaped while still attached to the leg, shortening the time the flap spends without blood flow. In a meta-analysis, the jaw angle came closer to the plan with virtual planning, while differences in time did not reach statistical significance (Pucci and colleagues, International Journal of Oral and Maxillofacial Surgery, 2020).
Teeth and dental implants
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Implants at the same operation
Dental implants placed into the fibula during reconstruction survived in 92.5 percent of cases, against 88.5 percent when placed later, in a meta-analysis of patients with oral cancer (Dugast and colleagues, 2025).
Radiotherapy weakens bone healing. A systematic review found implant survival of 93 percent in non-irradiated fibula, falling to 38 percent when implants were placed within 12 months after radiotherapy and 77 percent at 24 months, and only about half of patients reached a dental prosthesis overall (Nham and colleagues, Journal of Stomatology, Oral and Maxillofacial Surgery, 2023).
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Our approach
When radiotherapy is likely, we discuss placing implants during the reconstruction, so that teeth can be restored without waiting years.
Risks
Swelling of the face and neck for several weeks.
Temporary difficulty swallowing and speaking.
Numbness of the donor site and the reconstructed area.
The flap can lose its blood supply in the first days. Hourly checks detect trouble early, and a return to theater within hours saves many threatened flaps.
Complications after head and neck reconstruction
Complication
What happens
Management
Flap failure
Clot in the artery or vein
Return to theater within hours, second flap if lost
Fistula
Saliva leaks into the neck
Drainage, feeding tube, time
Wound infection
Neck or donor site
Antibiotics, drainage
Chest infection
Pneumonia after long anesthesia
Physiotherapy, antibiotics
Donor site problems
Graft loss, ankle stiffness, seroma
Dressings, physiotherapy
A second reconstruction
A lost flap is not the end.
In a German series of 996 free flap reconstructions, 220 cases involved two to six sequential flaps in the same patient, for recurrence or after failure of an earlier reconstruction, and those flaps succeeded in 89.1 percent, with diabetes the only identified risk factor (Moratin and colleagues, Plastic and Reconstructive Surgery, 2021).
Salvage is possible.
Speech and swallowing
Will I be able to speak and swallow normally after reconstruction?
Most patients speak and eat by mouth again, although how close to normal depends on how much of the tongue, throat or jaw was removed and on radiotherapy. Small tongue resections often leave near-normal speech. Large resections of the tongue base or throat may mean a softer diet and some change in voice. Speech and swallowing therapy starts in hospital and continues for months.
After total laryngectomy, the voice comes from a valve placed between the windpipe and the food passage, an electronic device or esophageal speech, and our speech therapists teach each method.
The hospital stay
A typical hospital course after free flap reconstruction
Time
What happens
Note
Operation
Eight to twelve hours
Cancer surgery and reconstruction
First one to two nights
Intensive care or high dependency unit
Hourly flap checks
Days 3 to 7
Ward, walking, physiotherapy
Feeding tube, tracheostomy care
Days 7 to 14
Swallow assessment, tracheostomy removed
Diet resumed step by step
Discharge
Ten to fourteen days
Longer after major throat surgery
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Flap monitoring
Nurses check the color, warmth and blood flow of the flap with a handheld Doppler every hour for the first days.
A temporary tracheostomy keeps the airway safe while the mouth and throat are swollen, and a feeding tube provides nutrition until swallowing is assessed. Both are removed in most patients before discharge.
Family
Once the critical first days have passed, one family member can stay in the room with the patient day and night, which helps with care and with communication while speaking is difficult.
Radiotherapy and timing
Many patients need radiotherapy or chemoradiotherapy after surgery, ideally starting within six weeks. Reconstruction with well-vascularized flaps lets wounds heal quickly enough for treatment to begin on time.
Typical sequence of treatment
Stage
Timing
Purpose
Surgery with reconstruction
Week 0
Remove the cancer, rebuild
Recovery and wound healing
Weeks 1 to 4
Ready for radiotherapy
Radiotherapy or chemoradiotherapy
Starting by week 6
Lower the risk of recurrence
Dental implants or prosthesis
After healing, timed with radiotherapy
Restore chewing
Radiotherapy at our hospital
Radiotherapy is delivered on our Elekta Versa HD linear accelerator, and the tumor board coordinates surgery, radiotherapy and medical oncology in one plan.
Rehabilitation
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Months of work
Speech and swallowing therapy, physiotherapy for the shoulder after neck dissection, scar care, dental rehabilitation and nutritional support continue for months.
Lymphatic swelling of the neck and face, shoulder stiffness and dry mouth after radiotherapy each have specific treatments, and early therapy prevents long-term problems.
The team
Many specialists share this work.
Head and neck surgeons, reconstructive microsurgeons, oral and maxillofacial surgeons, radiation and medical oncologists, anesthetists, intensive care nurses, speech therapists, dietitians, dentists and prosthodontists all plan together before the first incision, and the tumor board reviews each case.
No single specialist can do it alone.
For patients from abroad
Plan for three to four weeks in Istanbul for surgery and recovery, longer if radiotherapy follows here. The length of stay depends on the extent of surgery and how quickly swallowing returns. Fitness to fly is confirmed at the last visit, once wounds have healed and swallowing is safe.
Bring a family member. Patients need support in the weeks after discharge.
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What to send
Biopsy report, CT or MRI of the head and neck, PET/CT if done, dental X-rays, a summary of earlier treatment and medical history.
After you return home, follow-up continues by video and with scans sent to us, at intervals agreed with your local oncologist. Radiotherapy can be given here or near home, coordinated with our team.
One coordinator from the international patients office handles arrangements from the first message through discharge and answers the same WhatsApp number after you return. The office works in English, Arabic, French, Russian, Serbian, Romanian and Spanish and books interpreters for other languages, and it arranges the visa invitation letter, airport transfers, daily transport and accommodation near the hospital. Halal, vegetarian and diabetic meals, a prayer room on site, and a female physician on request wherever the rota allows.
Cost
The price depends on the extent of the cancer surgery, the type of flap, virtual planning, dental implants and the length of stay.
What a quote covers
What a quote for head and neck reconstruction covers
Item
Included
Priced separately
Surgery
Cancer resection, neck dissection, free flap
Second operations
Planning
Imaging review, virtual planning where needed
Custom plates, implants
Hospital
Intensive care, ward stay, therapy
Radiotherapy, chemotherapy
We quote after the tumor board reviews your scans and pathology, before you travel. Compare quotes that include both the cancer surgery and the reconstruction by the same team.
Elements that change the price
Element
Effect
Note
Bone flap with virtual planning
Higher
Guides and plates manufactured
Primary dental implants
Higher
Fewer later operations
Longer intensive care stay
Higher
Major throat surgery
References
de Berker HT, Čebron U, Bradley D, et al. Outcomes of microsurgical free tissue transfer performed on international surgical collaborations in low-income and middle-income countries. A systematic review and meta-analysis. J Plast Reconstr Aesthet Surg. 2022;75(7):2049-2063.
Pucci R, Weyh A, Smotherman C, Valentini V, Bunnell A, Fernandes R. Accuracy of virtual planned surgery versus conventional free-hand surgery for reconstruction of the mandible with osteocutaneous free flaps. Int J Oral Maxillofac Surg. 2020;49(9):1153-1161.
Dugast S, Longis J, Anquetil M, Corre P, Komarova S, Bertin H. Assessing dental implant success. A systematic review and meta-analysis of primary versus secondary implantation in free bone flap reconstruction for malignant tumors. Head Neck. 2025;47(4):1277-1290.
Nham TT, Koudougou C, Piot B, Corre P, Bertin H, Longis J. Prosthetic rehabilitation in patients with jaw reconstruction by fibula free flap. A systematic review. J Stomatol Oral Maxillofac Surg. 2024;125(3):101735.
Moratin J, Horn D, Heinemann M, et al. Multiple sequential free flap reconstructions of the head and neck. A single-center experience. Plast Reconstr Surg. 2021;148(5):791e-799e.
Editor's note
Written by the Biruni Hospital medical editorial team. Reviewed by Assoc. Prof. Dr. Fatih CERAN, Plastic, Reconstructive and Aesthetic Surgery.
