today my dad had surgery to remove his tongue cancer. Originally it was planned for a forearm free flap, but the dr called to say they are proceeding with a pec flap instead as some branches of the carotid artery and jugular vein were removed. I guess there were issues with them due to radiation, but a suspicious node was nearby. To prevent further spread, these were partially removed. As a result, pec flap was done to avoid any potential damage to other side of neck. I always knew this was a possibility, but there was never discussion of the arteries. What does this mean long term wise and with quality of life. He's still in surgery so I Am a nervous wreck.

Im sorry to hear what your father is going thru! Try not to panic and think too far ahead. The change in surgery was likely the result of what the doc discovered when they began the surgery. To me, it sounds like your father is in good hands. Every single patient will react in their own unique way and at their own pace. Its not possible for us (caregivers and patients) to know his long term QOL, it would be just guessing.

Ive had a neck dissection and a pec flap when I had my mandibulectomy in 2009. My situation was very different due to complications I had. It can be a long recovery for many patients with at least 5-10 days in the hospital and months of recovery later. One tip I learned is to keep ahead of the pain. The first week or so can be pretty bad. Maybe Im wimpy but I had my doc prescribe 2 pain meds so I could alternate between the 2 and never have to wait for the next dose if I was hurting.

Hang in there, please keep us posted. Dont forget to take time just for you and be kind to yourself. You have alot on your shoulders with so many things depending on you.

(((HUGS)))

Christine thank you so much for the supportive words. I will talk to the dr about pain meds because he has a trach and can't speak due to the swelling. You've also been through so much- your strength is amazing and inspiring.

I had 5 neck dissections, three that were radical. The last one, a year ago with the main section of thecarotid artery removed, no vein graft, vagus nerve, and others. This supplies blood to the brain. The previous pec flap was enough to sufficiently cover it again since there are still surgical stubs, and previously had my neck muscle, vein, and nerve removed back in 2011 whereby they put alloderm on carotid to protect it. The Pec Flap will help protect the carotid from damage, erosion by fluids from, leakage, and more radiation can be given with fresh tissue, if needed, I did.

There is also the external carotid artery, that branches off the main carotid/ internal carotid supplying blood to the facial tissue, muscles. I don't know which it was or the same as mine, but I can try to help answer some questions you may have after you speak with the doctors, and your husband recovers.

Wishing all the best.

Hi Paul thanks for replying. I guess I don't know what yo expect. They used the pec muscle to reconstruct his tongue. Nurse explained it as flipping the muscle and pulling it through the neck to the tongue and stitching it. It's amazing what doctors can do. Do you have any restrictions from the pec flap? Did you need PT? Any complications from the carotid/jugular vein removal. Dr said he wouldn't need it because he has the other side but it was a decision made Turing surgery so I don't know what to expect symptom wise. It's 1 day post surgery and he's in a lot of pain in his chest and head. The trach is freaking him out to the point where he can't sleep due to fear. I've been here all day to comfort him to sleep and he finally getting some rest.

I was thinking the pec flap was placed in the neck after the neck dissection. That's where mine is, and I heard of the surgery you described for the tongue, but mine was oropharyngeal cancer to the lymph nodes. Everyone is different. I didn't need PT from surgery until I had a few of them, but it still wasn't that bad compared to needing PT from chemo. Now I have a few issues that are related to all the treatments I had, and need PT again.

I had no issues with the jugular vein removal a few years ago, but possibly with the vagus nerve, carotid artery removed last year, and whatever other nerves possibly removed like the accessory, phrenic nerve. Really not sure anything can be pinpointed to blame since I had a number of radiation treatments, and surgeries, and just in the diagnostic phases.

See where it goes once discharged. So many things may or may not occur, but the doctors and his health team are best right now for information, treatment and guidance, and of course your support. I didn't have a trach, so I'm not familiar with it, other than sharing pain, which needs to be addressed, and can interfere with healing.

If the doctors say "He won't need it because he has the other side" assuming he carotid artery, later on you want it to keep the other side working, which may entail diet, medications, imaging studies and surveillance, but again, we may be talking about a different area than mine.

Good luck

Thanks for your prompt reply Paul. I am hoping he starts to feel better later this week. He may or may not need PT, he did have a previous neck dissection in May and already had radiation for another site this summer. His neck has always been quite tight so it may not hurt to try it out.

Did your scars heal well? We were concerned with him having 2 neck dissections in a short period of time might make it more visible.

ConcernedDaughter

I remember when my mom had the Trach for a couple of days after her surgery and she was frighten of it also. If I am not mistaken The doctor ordered her on Propofol Sedation until it was removed. I remember the sedation wearing off one night and she panicked and tried to pull it out. Hopefully your father doesn't have the Trech for to long.

Good Luck
Heidi

Well he did have a panic attack this morning and started to hyperventilate. The nurses were able to calm him down fairly quickly but they said if it continued they may give him some anxiety medication to help with sleep too. He wouldn't go to bed at all...he finally got some rest hopefully things start to improve from here. The doctor said it's only temporary for maybe a week. I sure hope things stay in that time frame.

Oh yes I remember when the sedation wore off and my mom was banging on the railings of the bed for attention. Her hand was bruised from banging so hard. She panicked and let us know she couldn't breath. The doctor said the nurses should have been monitoring the sedation more closely and that shouldn't have happened. My mom had the trech for about 4 days . I don't think she could have stood it without the sedation.

After the trech came out I gave my mom a little note pad and pen so she could let us know what she needed.

Hopefully you father wont need the Trech for to long.

Good Luck
Heidi