Pete,

Excellent post! This should be on a list of FAQs or something.

Well done.

- Margaret

[quote]I would still try to get another opinion from a CCC[/quote] Parovis is scheduled to have this done tomorrow...

The whole free flap thing is dependent on how much tongue needs to be removed and if a flap is proposed, then that implies a significant amount of tongue to be lost.

The procedure is quite complex -- Both my flaps were scheduled for ten hours in the OR -- Since this is not a simple thing, I infer that either a CCC or serious cancer facility is already involved -- This is not something a lone practitioner would do.

Here's what my 'radial forearm free flap' procedure involved:

The gas-passer had to put me out for the ten hours.

The naso-gastric tube had to be installed (not needed if PEG in place).

The tracheostomy had to be done.

The throat had to be opened for the neck dissection and anything removed prepared for the pathology lab.

The cancer had to be removed from the tongue and prepared for the pathology lab. The remaining tongue had to be prepped for fastening the flap to it and floor of mouth.

The free flap had to be harvested from the wrist donor site.

The flap's blood vessels had to be attached to the neck dissection blood vessels by surgeon with trusty hooded microscope -- Eight micro-sutures per vessel.

The flap had to be installed and fastened to remaining tongue and floor of mouth.

The skin graft had to be harvested from the thigh and the resulting wound covered with that nifty 'crumble as it heals' gizmo and sutured to stay put for a while.

The graft had to be installed and sutured to the wrist donor site and the drain(s) installed.

All the throat-cutting done by the Cutthroats had to be closed and sutured (literally hundreds of sutures and staples were involved) and the drains were installed (I think I had about five drains at first).

Very good and descriptive posts Pete. My surgery for my free flap and mandible replacement was 18 hours and there was quite a team involved. I still have shaken the hand of everyone that made it possible yet - probably only 1/2.

Parovis it is still your decision, but at 39 you have a lot of years ahead of you. There are no guarantees with cancer - you can do a lot or a little in the surgery/treatment and it may or may nor come back. Do what you are most comfortable with and know that we will all be here supporting you both during and after your surgery.

Patty

The free flap surgery is a loooong procedure. Mine was 14 1/2 hours followed by an 11 day hospital stay.

That was a really good description of the procedure, Pete. I didn't have the graft put on my arm in the same surgery as I've mentioned before, but everything else was the same.

Had much the same as others have mentioned including Pete's first free flap surgery.
Have had a few issues since then with the section between the flap and tongue.
In fact had another (day surgery only) operation yesterday.
The operation went well and even though I had a fair bit of pain and swelling yesterday I am feeling a lot better his morning.
With the help of Panadeine Forte I managed to sleep well for 5 hours straight last night.
Counted 15 stiches which means there are probably more.
They did take a small graft from inside of cheek to put over the area as a barrier but from the same side which is good!
On a liquid diet again for a week.
Gabriele

Gabe I hope that you get more than 5 hours sleep tonight and heal rapidly.

Patty

Thanks for all of the replies. Don't know if I made a hasty decision but once I found out I had cancer, I was ready to make a move for fear of spreading.

I went with the free flap. I made the decision the morning of surgery. Everything went well. About 25% of tongue removed. 10 and half hours of surgery and as of yesterday, back home and recovering.

Other than it looking pretty bad, overall, i'm feeling pretty good. Trusted my doctor and plastic surgeons on the free flap. Think I made the right decision. So far, clear margins and negative on the nodes.

Just trying to heal. Would also like to find out why this happened, although probably won't. I'm not a smoker or drinker so not sure what else could have caused this, if anything other than genes. Would be very curious though to do a study on lifestyle products we use as I read oral cancer jumped 11% in 2007 alone and mainly in younger people.

Makes you wonder....

Glad to hear that you are home and on your way to recovery. Clear margins and negative nodes are great.

Try doing a search on the site for HPV. There was also a thread recently on alcohol in mouthwashes. There are many different thoughts on the causes.

Patty