This is the reconstruction of the defect left by removing a tumour: closing what was left open, restoring the shape and, where appropriate, recovering function.
Removing a tumour with adequate margins leaves a defect, and that defect has to be closed. On the face it may involve the eyelid, the nose, the lip or the ear; on the trunk or limbs it may leave bone, tendon or prosthetic material exposed. Oncologic reconstruction is the discipline that resolves that closure, and its logic is different from that of cosmetic surgery: here the priority is to cover, to restore function and to let the cancer treatment continue without delays.
The most important thing is when it is decided. The reconstruction is planned before the tumour surgery, not after. When the cancer surgeon knows the defect has a solution, they can resect as widely as the disease demands; when they do not know, there is a temptation to be conservative with margins, and that harms the patient. Having the reconstruction planned is, in itself, a measure of the quality of the cancer treatment.
It usually helps when there is
- A defect foreseen after removing a tumour, planned in advance.
- A facial defect involving the eyelid, nose, lip, ear or cheek.
- Exposure of bone, tendon, cartilage or prosthetic material.
- A wound that cannot be closed directly because of its size or location.
- A functional or aesthetic consequence of a previous cancer resection.
Worth discussing first if
- Margins not yet confirmed, which may make temporary coverage advisable.
- Active cancer treatment, which determines the timing of the reconstruction.
- Current smoking, decisive in any flap.
- Advanced disease, where the goal may be palliative.
- General health that will not tolerate a prolonged operation.
None of these rules the procedure out on its own; all of them change the conversation.
What it is reconstructed with
The simplest option that solves the problem well is always the one used.
Direct closure
When the defect allows it, making use of the elasticity of the skin and orienting the scar along the natural lines.
Skin graft
For superficial defects with a good bed. It is quick and safe, although it leaves a difference in colour and texture.
Local or distant flap
Brings tissue with its own blood supply. It is the option when structures are exposed or when the result on the face has to be good.
The reconstruction does not limit the resection
It is the rule that orders everything else. The resection is defined by the disease, not by how difficult the closure is. An insufficient margin to leave a defect that is more convenient to reconstruct is a bad bargain: recurrence forces a second operation on already-operated tissue, harder and with a worse outlook.
The principle of the reconstructive ladder applies: start with the simplest option that solves the problem well and climb only as far as necessary. A microsurgical flap that was not needed adds risk and operating time with no benefit.
When the margins are not confirmed at the time of surgery, temporary coverage may be chosen and definitive reconstruction carried out when the pathology report arrives. That is preferable to reconstructing over a margin that will later have to be widened.
What the process is like
Joint planning is the part that most determines the result.
Joint planning
Before the cancer surgery, the expected defect is discussed with the treating team and the coverage strategy is defined.
Surgery
Removal of the tumour and reconstruction in the same operation where possible, or temporary coverage while waiting for the pathology report.
Pathology result
If the margins are involved, they are widened before completing the definitive reconstruction.
Refinements
Months later, contour adjustments, scar correction or fat grafting can be done to improve the final result.
What to expect
It varies considerably with the size of the defect and the technique used.
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Days 1 to 10
Frequent dressings and monitoring of the flap or graft. Rest for the reconstructed area. Hospital stay according to the size of the surgery.
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Weeks 2 to 6
Healing consolidated and stitches out. Activity resumed gradually. Additional treatment can begin if it was indicated.
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Months 2 to 6
The reconstructed area softens and integrates. Physiotherapy if there is functional involvement.
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Months 6 to 18
Time for refinements: contour touch-ups, scars and fat grafting. Cancer follow-up continues throughout.
Risks, and what is not promised
Those specific to each technique: partial or total loss of the flap, loss of the graft, infection, haematoma, wound breakdown and complications at the donor site. In microsurgery, thrombosis of the vascular pedicle is added, which may force an urgent reoperation.
Radiotherapy before or after worsens healing and increases all of these complications. Smoking is the modifiable factor that weighs most, and in flap surgery its impact is large.
Restoring the original anatomy is not promised: an acceptable shape and function are reconstructed, not the tissue that was there. In large facial defects the result usually requires several stages and does not erase the mark of the illness. These risks are reduced by a technique matched to the defect and by giving up smoking. They are not eliminated. The ones that apply to your case are set down in writing in the informed consent.
The information on this page is for guidance and does not replace an in-person medical consultation. Medical practice is an obligation of means, not of result.
The questions we are asked most about oncologic reconstruction
Often yes, and that is preferable: one operation, one anaesthetic and a wound closed from the start.
When the margins are not confirmed, temporary coverage may be chosen and the reconstruction done afterwards. That is preferable to reconstructing over a margin that will later have to be widened.
It should not, and that is one of the aims of the reconstruction: a closed wound allows the additional treatment to start on time.
An open wound or a flap with complications can delay it, and that is why the safest technique for each patient is chosen, not the most ambitious.
No. An acceptable shape and function are reconstructed, not the original tissue, and in large defects the difference shows.
What is sought is a result that lets you live normally, with your face uncovered and without functional limitation. In many cases that is achieved well.
Because knowing the defect has a solution lets the cancer surgeon resect as widely as the disease demands, without falling short for fear of the closure.
It is a measure of the quality of the cancer treatment, not a logistical detail. When the closure is improvised at the end of the operation, the result is usually worse on both fronts.
Question not answered here? There are more answers in the frequently asked questions.
