The pinnacle of head and neck plastic surgery. Dr. Manish Tiwari expertly harvests and integrates two independent microvascular free flaps in a single operation to rebuild massive bone and soft tissue defects, restoring complex facial anatomy.
Complete removal of the mandible or maxilla requiring a rigid, 3D bone structure replacement.
Tumors that have breached the outer facial skin, requiring separate external skin reconstruction.
Extensive loss of the tongue, mouth floor, and buccal lining that one single flap cannot cover.
Rebuilding facial zones severely damaged by previous high-dose radiation treatments.
Standard reconstruction uses one piece of tissue. However, massive T4b oral cancers often destroy the jawbone, the inner mouth lining, and the outer cheek simultaneously. Rebuilding this requires the ultimate surgical solution: two simultaneous transplants.
Performing a Double Free Flap requires harvesting tissue from two different donor sites (like the leg and the arm), bringing them to the face, and delicately sewing four to six tiny blood vessels together under a high-powered microscope.
The foundation of the face. We typically harvest the Free Fibula Flap (FFOCF) from the lower leg. The bone is cut and sculpted with titanium plates to perfectly recreate the curve of the jaw (mandible or maxilla).
While the fibula rebuilds the bone, we simultaneously transplant an ALT Flap (Thigh) or Radial Forearm Flap (RAFF) to rebuild the tongue, mouth floor, or external cheek skin.
Dr. Tiwari orchestrates a highly synchronized surgical team to ensure the safe harvest, transfer, and anastomosis of multiple tissues in one seamless operation.
The cancer is aggressively cleared, creating a complex defect that spans multiple tissue types (bone, muscle, skin).
While the head and neck are prepared, the reconstructive team carefully harvests the Fibula bone and the separate soft tissue flap, preserving their critical blood vessels.
Using sutures thinner than a human hair, Dr. Tiwari connects the arteries and veins of both flaps to the recipient vessels in the neck, establishing vital blood flow.
Double free flap surgery has no margin for error. A failure in microvascular connection can lead to complete tissue death.
The first 48 hours are critical. Our patients recover in dedicated Microvascular ICUs.
