What happens when..... the fibular free flap fails due to lack of blood flow thru the tissue, a pectoral flap is then done (leaving the bone in place), then a fistula causes an infection damaging that bone and the reconstructive surgeon wants to do another free flap after radiation.

My questions are - does anyone know...

Where is the next most likely donor source for the free flap?

What happens with the pectoral muscle that was already cut to make a flap? This muscle is pulled up thru the left side of his neck.

What are that chances that a 2nd free flap would fail, especially since this next surgery will be post radiation?

If anyone knows or has any experience in multipe reconstructive proceedures, it would be great to get some input. We won't see the surgeon until 2 months post rads, which will be mid November and I am hoping to get a handle on what might come next.

Karen
not really got a positive answer for you.
My graft was taken from the inside of my forearm, seems to be first choice here in the UK. I was told when I had some problems with tissue dying that a pectoral graft would have been the surgeons next choice.
So maybe a forearm graft is something you can ask about, surgery after radiation I cannot help with. BUT is there any chance that the fistula will heal with time(I suppose that is wishful thinking on my part.)
Wish I could help more..
Sunshine.. love and hugs
Helen

We think that the fistula has healed. At least there is not any more infection. However, it could possibly still be there as there is still drainage every day from just below the chin. This extra little hole in the bottom of his chin occured when the infection finally broke thru the skin. The doctors seem to prefer that it remain open and draining, because the bone is deteriorating and this hole seems to keep things from backing up in this area causing another infection.

It isn't painful, so that is good.

It is the bone deterioration that is the doctor's next concern. That will never fix itself, it will only get worse. The Pectoral graft already was done, just 4 days after the original fibular free flap failed, but that doesn't help the problem with the bone.

For having so many problems, the only concern he had today is the thick mucas from radiation. It has already started and he has only had 10 treatments. I guess he is taking it better than me and just worring about what bothers him today, and not about what might bother him tomorrow.

Hi Karen

During my first surgery my tongue flap was taken from my inner thigh.

Following that surgery I had radiotherapy and chemotherapy.

I then had to have nearly all of my mandible reconstructed due to Osteroneocrosis from the radiotherapy. During that surgery they removed bone from my hip to reconstruct my mandible and also used tissue from my hip area to do another reconstruction of my tongue flap.

When they were discussing reconstructing my mandible and tongue flap with me before the surgery they also mentioned that bone from my shoulder blade and tisssue from that area might also be suitable.

Hope this helps a little.

Like your husband I began suffering with the thick horrible mucus after my 10th rad, I know how he would be feeling it is unbearable and it feels like it is NEVER going to go away, but it does.

Best wishes to you and your husband

Karen

Karen,
My flap also failed because of blood flow. I had part of my jaw
removed and reconstruction from my shoulder bone. After 22
days, it failed and I had to have emergency surgery to remove
the flap and the bone and then my pectoral muscle put in to hold
me together.
I have had some of my bone resorb and I have a loose molar to this day. My oncology dentist wants to pull it before it becomes infected, but I went to my regular dentist for a cleanng and he freaked out and sent me to a specialist who was his friend. This guy told me just to wait it out and check on the bone after a couple of months, as long as It did not get infected.
My ENT liked his advise, because he said an oral surgeon would
want to replace my whole jaw with a metal tray. Oh how horrible.
He suspected that all the holes they drilled into my jawbone to
install the bone from my back were causing the resorption and that it would eventually heal over. I am still waiting, I have an
appointment in September for a panorex to check on bone loss.
I feel anymore trauma to the bone, like in pulling that tooth would just cause more bone loss.
I quess my point is that you have to weigh everything that is told to you. Oral surgeons sometimes go way overboard.
It is just a waiting game and somedays I am comfortable and some days I would love to have this tooth gone.
Good luck to you,
Feel free to PM me if you have any questions (or anwers)!!
Debbie