The ultimate solution for rebuilding massive head and neck defects. Dr. Manish Tiwari expertly harvests bulky, versatile tissue from the thigh to flawlessly restore major facial contours, total tongue resections, and complex skull base defects.
Providing the immense bulk required to replace the entire tongue and restore swallowing dynamics.
Rebuilding massive cheek tumors that have destroyed both the inner mouth lining and outer facial skin.
Filling the large empty cavity left behind after removing the upper jaw to prevent facial collapse.
Providing robust, vascularized muscle to safely seal the brain cavity off from the oral and nasal airways.
When cancer eradication leaves a massive "dead space" in the face or neck, thin flaps are insufficient. The Anterolateral Thigh (ALT) flap provides the immense volume and flexibility needed to rebuild complex, 3-dimensional facial structures.
The thigh provides an abundance of skin, fat, and the vastus lateralis muscle. This allows Dr. Tiwari to safely fill massive voids—such as after an ITF compartmental clearance—preventing devastating facial hollowing.
The ALT flap is highly customizable. It can be harvested as a "chimeric flap," meaning Dr. Tiwari can take separate islands of skin and muscle on a single blood vessel leash to rebuild the inside and outside of the mouth simultaneously.
Unlike forearm flaps that leave a visible scar on the arm, the ALT flap is taken from the upper thigh. The resulting scar is easily hidden under standard clothing, offering a significantly superior aesthetic outcome for the patient.
Dr. Tiwari utilizes a highly synchronized two-team approach, ensuring the tumor is eradicated while the thigh tissue is perfectly prepared for immediate transplant.
The head and neck oncology team completely excises the massive tumor, defining the exact dimensions and depth of the required reconstruction.
The reconstructive team meticulously isolates the delicate "perforator" blood vessels from the descending branch of the lateral circumflex femoral artery in the thigh.
The large thigh tissue is transferred to the face. Using high-powered surgical microscopes, the tiny blood vessels are sewn into the neck arteries, instantly restoring blood flow and bringing the tissue to life.
Because the blood vessels (perforators) in the thigh vary from person to person, precise mapping is required before surgery.
Patients require careful monitoring of the new facial flap while simultaneously recovering leg mobility.
