Microsurgery and Reconstruction

On this page

• Facial paralysis
• Facial synkinesis
• Facial reanimation
• Nerve grafting and transfers
• Muscle transfer
• Botox and adjunctive procedures
• Treatment goals and patient expectations

What Does Facial Paralysis and Facial Reanimation Include?

Facial paralysis and facial reanimation include the evaluation and treatment of loss of facial movement and the asymmetries that result from it. Although Bell’s palsy is one of the most common causes, facial paralysis is not limited to this alone. It may also occur after trauma, after nerve injuries, as a result of previous surgery, or in congenital conditions. In some patients the paralysis is temporary, but permanent facial paralysis is also very common.

In my approach, facial reanimation is not a single procedure. It is a comprehensive treatment field planned according to the cause of the paralysis, how long it has been present, and the patient’s remaining function.

What Are the Most Common Complaints in Facial Paralysis Patients?

The most common complaints in these patients are asymmetry during smiling, weak smile strength, inability to close the eyelid adequately, lack of brow movement, and overall facial imbalance.

In some patients, the main issue is that one side of the face does not move. In others, the opposite problem is present: certain muscle groups become overly active, creating an imbalanced appearance. For this reason, not every facial paralysis patient is evaluated in the same way.

What Is the Main Goal of Treatment?

The main goal of treatment is to restore balance to the face. If there are weak muscle groups, they need to be supported. If there are overly strong or unbalanced muscle groups, they need to be weakened or balanced.

In practice, our goals are:

• to improve smile symmetry
• to strengthen the smile
• to improve eyelid closure
• to restore the overall balance of the face

In other words, the goal is not simply to move a single muscle, but to make the face more balanced both functionally and aesthetically.

Which Treatment Options Are Used?

There is no single method for treating facial paralysis. More than one approach may be necessary depending on the patient. The methods used may include:

• nerve grafts
• muscle transfers
• balancing with Botox
• relaxing or, in selected cases, reducing overly active muscles
• supportive eye procedures such as canthopexy
• placement of a gold weight in the eyelid
• brow lift
• complementary procedures such as facelift and fat grafting

In some patients, only one of these treatments is sufficient, while in many others the treatment is planned in stages and in combination.

In Which Patients Is Nerve Grafting Considered?

If the facial paralysis has developed recently, meaning within approximately the last 6 months to 1 year, nerve grafting should be considered without delay. In these patients, the facial muscles may still remain viable, and very good results may be possible if nerve conduction is restored before irreversible muscle loss occurs.

In nerve grafting, a sensory nerve taken from the leg is usually used as an interposition cable graft. Removing this nerve does not cause loss of movement in the leg. There may be some decreased sensation in a limited area, but the body generally tolerates this well.

This nerve is used to carry signal to the paralyzed side from functioning nerves on the healthy side of the face or, in some cases, from sources such as the nerve to the chewing muscle, nerves from the shoulder region, or the contralateral healthy facial nerve. The goal is to create stronger and more meaningful contraction on the paralyzed side.

In Which Patients Is Muscle Transfer Necessary?

If the paralysis has been present for many years, or if the condition is congenital, nerve grafting alone is not enough. In that situation, the muscles may no longer be capable of responding to a nerve signal.

In these patients, muscle transfer is required together with nerve grafting. One of the most common methods we use is transfer of the gracilis muscle taken from the inner thigh to the face. This muscle has functional reserve in the body and is a very valuable option for facial reanimation in appropriately selected cases.

Through a small incision, the muscle and its nerve are taken from the leg and then transferred to the face. These are complex procedures that require not only microsurgical knowledge, but also an understanding of peripheral nerve surgery and facial aesthetics.

When Are Botox and Complementary Procedures Used?

Botox and complementary procedures may play a role both in the milder side of facial paralysis treatment and as part of more complex surgical rehabilitation.

In partial paralysis, they may be used to:

• balance mild asymmetries
• weaken overly strong muscles
• support the brow
• create better balance around the eyes

In complete paralysis, additional procedures may also be performed to further improve the result obtained after nerve grafting or muscle transfer. These may include:

• gold weight placement in the eyelid
• suspension procedures
• canthopexy
• brow lift
• small muscle procedures in selected patients
• fat grafting
• facelift

In other words, these procedures are not alternatives to the main treatment; in most cases, they are part of it or a continuation of it.

Should Aesthetics and Function Be Considered Together in Facial Paralysis?

Absolutely. In facial paralysis treatment, restoring movement alone is not enough, because the face is also at the center of aesthetic balance.

In patients who have lived with facial paralysis for many years, volume loss, sagging, and clear contour differences may develop on the paralyzed side. For this reason, some patients may also require facelift, fat grafting, or other aesthetic supportive procedures.

This is why I do not see this field as nerve surgery alone. Facial reanimation requires function and aesthetic balance to be addressed together.

What Makes Your Approach Different in This Field?

What makes me different in this field is not simply that I perform microsurgery, but that within microsurgery I have focused specifically on peripheral nerve surgery.

I am a surgeon who has completed advanced microsurgical training and who has also specifically concentrated on peripheral nerve surgery within that field. In addition, because I frequently perform facelift and other aesthetic facial procedures, I am able to evaluate facial paralysis patients not only from the nerve perspective or only from the aesthetic perspective, but from both together.

In my practice, microsurgery, peripheral nerve surgery, head and neck dissection, and aesthetic facial surgery come together under the same roof. The intersection of these fields creates an important advantage in facial reanimation.

What Should the Patient’s Expectations Be?

The expectation in these patients should not be perfect symmetry. In facial paralysis treatment, the goal is most often to make the patient better. Although complete and flawless symmetry is not always possible, in many patients it is possible to achieve better smile symmetry, a stronger smile, and a more balanced facial expression.

My general approach is this: in the great majority of patients, meaningful improvement is possible. The goal is not perfection, but meaningful improvement.

Another important point is that these treatments often do not end with a single operation. Facial paralysis surgery frequently progresses in stages. In many patients, several procedures are planned in sequence in order to achieve incremental improvement at each stage. For this reason, it is more accurate for the patient to see treatment not as one operation, but as a reanimation journey.

Common Patient Scenarios

My child was born with facial paralysis. What should we do?

In children with congenital facial paralysis, surgical planning for facial reanimation may be considered once the child reaches approximately 5–6 years of age. One of the most effective options in this group is gracilis muscle transfer from the thigh.

In most cases, this treatment is planned in two stages. First, a nerve grafting procedure is performed. This is usually the shorter and smaller operation. In the second stage, the muscle transfer itself is planned as a larger reconstructive procedure. The exact timing should be determined after detailed evaluation of the child.

I developed facial paralysis about 4–5 months ago, but some recovery has already started. What should I do?

You have most likely experienced Bell’s palsy. Most cases improve spontaneously over time. However, if there is still no meaningful movement by around 6–7 months, both further investigation and surgical planning become important.

If you already have clear return of movement within the first 6 months, most of your facial movement will likely continue to recover. However, some patients may still develop partial weakness or facial synkinesis, meaning unwanted muscle contractions that appear during movement. In such patients, supportive treatments may be needed, including Botox, selective weakening or removal of overactive muscles, or in some cases small nerve procedures.

I had an accident, and one side of my face became completely paralyzed. What should I do?

If complete facial paralysis develops after trauma, the first question is whether the facial nerve can still be repaired directly. If repair is possible, this should ideally be planned within the first 6 months.

If the nerve cannot be repaired directly, then nerve grafting or nerve transfer procedures should be considered as early as possible, preferably before 6 months, in order to improve the chance of recovery. Early evaluation is very important in this group, because delay may reduce the options available later.

I had facial paralysis in the past but never received treatment. One side of my face still has no movement at all. What should I do?

If a long time has passed since the facial paralysis — especially more than 1 year — and the cause was an old trauma, injury, or cancer-related problem, the most effective reconstructive option is usually muscle transfer.

In this group, gracilis muscle transfer can be planned in selected patients. When the native facial muscles have been inactive for too long, nerve procedures alone are usually no longer enough, and a functional muscle transfer becomes the main reconstructive solution.

Short FAQs

Is the same operation performed for every facial paralysis patient?

No. Treatment varies according to the duration and cause of the paralysis, and according to how much function remains in the face.

Is nerve grafting or muscle transfer needed?

In recently developed paralysis, nerve grafting is considered more often. In long-standing or congenital paralysis, muscle transfer is also needed.

Does taking a nerve or muscle from the leg cause major loss in the leg?

Generally no. The nerves and muscles used for this purpose can be taken safely, and the body usually tolerates this well.

Does Botox also have a role in facial paralysis treatment?

Yes. Botox is an important tool, especially in patients with mild asymmetry, overly strong muscles, or those who need balancing after surgery.

On this page

• Brachial plexus injuries
• Peripheral nerve injuries
• Early nerve repair and nerve transfer
• Muscle transfer in delayed cases
• Birth-related brachial plexus palsy
• Recovery timeline and patient expectations

What Does Brachial Plexus and Peripheral Nerve Surgery Include?

The brachial plexus refers to the network of major nerves in the neck that controls shoulder, arm, and hand movement. Injuries in this region can severely impair the function of the arm and hand. The most common causes are motorcycle accidents, falls from height, and injuries related to birth trauma.

Peripheral nerve surgery includes not only the brachial plexus, but also nerve injuries in different parts of the body. This field covers microsurgical repair of nerves in conditions such as facial paralysis and arm paralysis, and when repair is not possible, reconstruction of function through nerve transfers, muscle transfers, or tendon transfers.

For me, the essence of this field is not only seeing the nerve itself, but evaluating the soft tissue, scar tissue, and functional loss surrounding the nerve together.

Which Patients Fall into This Group?

The most common patients in this group are:

• brachial plexus injuries after motorcycle accidents or other high-energy trauma
• brachial plexus palsy related to birth trauma
• peripheral nerve lacerations at the level of the hand, forearm, or arm
• patients who develop functional loss due to crushed, torn, or severely stretched nerves

In these patients, the main problem may be loss of shoulder movement, loss of elbow flexion, or impaired hand function. The treatment plan varies according to the level and severity of the injury.

How Is Treatment Planned in Brachial Plexus Injuries?

One of the most important factors here is time. If the injury is recent, especially if it can be evaluated within the first 6 months or, in some cases, within the first year, better results may be possible through nerve repair and nerve transfers.

During this period, surgeons may use:

• nerves taken from the leg
• healthy nerves in the neck
• healthy nerves in the arm and forearm that can be used without creating significant loss
• and in some cases, nerve sources taken from the opposite side or from around the ribs

to re-establish nerve conduction.

However, if a long period of time has passed since the injury, muscle tissue cannot wait forever, and nerve grafting alone is no longer enough. In that situation, muscle transfer is required.

In Which Cases Is Muscle Transfer Needed?

If a long time has passed since the injury and the muscle can no longer respond to nerve signals, muscle transfer becomes necessary. One of the most common methods we use in this setting is transfer of the gracilis muscle from the inner thigh.

This muscle can be harvested through a small incision, transferred to the arm or neck, and turned into a new source of movement through appropriate nerve connections. The same logic of muscle transfer that we use in facial paralysis can also be applied in some brachial plexus and peripheral nerve patients.

These are highly advanced microsurgical operations. They require not only technical knowledge, but also a strong command of soft tissue surgery, vascular and nerve anatomy, and safe work in heavily scarred areas.

Is the Approach Different in Birth-Related Paralysis?

Yes. The approach in brachial plexus palsy seen after birth can differ from that in other traumatic injuries. In these patients, some nerves may have partially recovered and some muscle function may still be preserved.

For this reason, nerve grafting or muscle transfer may not always be necessary in this group. In some patients, tendon transfers can improve shoulder and arm movement. In other words, the goal is not only to repair the nerve, but to increase function by using the remaining function in the smartest possible way.

What Is the Main Goal of Treatment?

The main goal in this field is to restore function. The basic objective is for the patient to be able to elevate the shoulder, bend the elbow, use the hand, or at least have a more stable arm in daily life.

Another goal that is just as important as function is stability. Even if full strength cannot be restored in some patients, achieving a more stable shoulder or a more useful arm can still greatly improve quality of life.

How Long Does It Take for Results to Appear?

One of the most important things these patients need to understand is the timing of results. In small nerve cuts or in certain injuries at the finger or hand level, the effect of surgery may be seen within a few months.

However, in major injuries, especially in brachial plexus surgery, it can take much longer for results to become evident. In some patients, meaningful improvement may take 1–2 years.

For this reason, the patient’s expectations must be long-term rather than short-term.

What Should the Patient’s Expectations Be?

The most honest thing to say here is this: the larger the injury and the longer the delay, the lower the chance of success. If the patient can be treated early, the results are usually better.

For this reason, during the in-person examination, it is important to explain clearly what can be regained, what can be improved partially, and what may remain limited. The goal is to offer the patient a realistic roadmap.

What Makes Your Approach Different in This Field?

The most important thing that distinguishes me in this field is that I trained for two years with Prof. Dr. David Chuang, one of the world’s most important names in brachial plexus and facial paralysis surgery.

During that period, I took part in many operations, and later I also performed these surgeries in Turkey as a university faculty member. Microsurgery and peripheral nerve microsurgery are fields that require very high experience and technical precision. In my practice, these fields have been shaped not only by theoretical knowledge, but by active and intensive surgical experience.

Where Does Orthopedics Fit into This?

Although I have performed hand surgery and bone surgery in the past, the main strength of plastic and reconstructive surgery—and of microsurgery—lies in soft tissue, vascular, and nerve surgery. For this reason, the nerve and soft tissue reconstruction side forms my main area.

If the patient requires additional orthopedic procedures involving the shoulder, elbow, joints, or major bone structures, collaboration with an orthopedist is appropriate. The bone and joint side is handled by them, while the soft tissue and microsurgical side is handled by me. When needed, this cooperation provides the patient with more comprehensive treatment.

Why Are These Operations Considered So Difficult?

Brachial plexus and peripheral nerve surgery are considered among the most advanced areas of soft tissue surgery. This is because nerve repair requires highly delicate techniques, and because these operations often take place within heavily scarred tissue.

Exposing the injured area and safely separating the tissues require a serious command of soft tissue surgery, the ability to work safely in scarred fields, and high experience. For this reason, these operations should not be seen merely as “nerve stitching” procedures; they are part of a much broader reconstructive surgical experience.

Common Patient Scenarios

I had a motorcycle accident 4 months ago and my arm is still paralyzed. They said I have brachial plexus damage. What should I do?

In this patient group, time is very important. If the injury is recent, the patient should be evaluated without delay and surgical planning should be made for nerve repair or nerve transfer. The first 6 months are usually the most critical period.

My baby was born with the arm paralyzed. They are now 3 months old and some movement is present. What should I do?

Most obstetric brachial plexus palsies can improve with physical therapy and close follow-up. However, if there is still no movement at 3 months, or if elbow flexion has not developed by 6 months, the likelihood of surgery is high and urgent evaluation is needed.

My child improved with physical therapy after birth palsy. They are now 8 years old, but shoulder movement is still limited. What can be done?

In this group, tendon transfers may improve shoulder movement and daily function. After examination, it should be assessed which movements can realistically be regained.

I had a motorcycle accident but declined surgery. It has now been 2 years. What can be done to regain movement?

At this stage, nerve repair alone is usually not enough. However, advanced reconstructive procedures such as muscle transfer can still be performed successfully, especially to restore key functions such as elbow flexion.

Short FAQs

What are the most common causes of brachial plexus injuries?

They are most commonly seen after motorcycle accidents, falls from height, and birth trauma.

Is nerve grafting or muscle transfer needed?

In the early period, nerve grafting is considered more often. In delayed cases, muscle transfer may be necessary.

Do results appear immediately?

No. Especially in major injuries, it may take 1–2 years for improvement to become evident.

Is an orthopedist also needed in these operations?

Yes, if there is a bone or joint problem. However, the nerve, vessel, and soft tissue side is my main field.

On this page

• Cancer-related and trauma-related tissue loss
• When free tissue transfer is needed
• Fibula flap and complex bony reconstruction
• Treatment goals, function and recovery
• Patient expectations and postoperative planning

What Does Head and Neck Reconstruction Include?

Head and neck reconstruction includes the repair of tissue loss that develops after trauma, burns, tumors, and cancer surgery in the head and neck region. This field does not simply mean filling a defect; it also requires reassessment of many functions such as eyelid movement, lip function, speech, swallowing, smiling, and neck movement.

For this reason, head and neck reconstruction is one of the most complex areas of reconstruction in which aesthetics and function must be considered together.

Which Patients Most Commonly Fall into This Group?

The patients who most commonly fall into this group are those who present with tissue loss after cancers of the face and head and neck region. In addition, deformities that develop after trauma, burns, and certain severe infections may also fall into this category.

In some patients, there may be only a small soft-tissue loss, while in others part of the tongue, lip, cheek, jawbone, or swallowing pathway may be missing. For this reason, not every patient can be evaluated in the same way.

In Which Situations Is Free Tissue Transfer Needed?

If the tissue loss is small, repair may be possible in some patients with simple skin advancement, local flaps, or skin grafting. However, if the defect is large, deep, or involves a functionally critical area, free tissue transfer is required.

In that setting, missing structures such as skin, muscle, nerve, or bone are taken from another part of the body together with their blood supply and transferred to the head and neck region using microsurgical techniques. Among the free tissue transfers we use most often and have the greatest experience with are the anterolateral thigh flap taken from the outer thigh, the fibula flap taken from the leg, and the gracilis muscle flap taken from the inner thigh.

The goal is not simply to fill a space, but to make the missing region more reliable, more viable, and more functional.

How Do You Work Together with Cancer Surgery?

If the problem is cancer, these operations are usually planned together with the team performing the cancer surgery. First, the tumor-bearing area is removed with safe margins, and then I step in as the reconstructive surgeon.

The goal here is not only to close the missing area. At the same time, we aim as much as possible to:

• restore volume loss
• preserve or regain function
• reduce salivary leakage, infection, and wound problems
• make the area safer and more durable if postoperative radiotherapy will be needed

In other words, the reconstruction performed here is not single-layered; it is a multi-dimensional reconstructive plan.

In Which Patients Does the Fibula Flap Stand Out?

If trauma or a tumor involves the mandible or maxilla, one of the most valuable options for bony reconstruction is the fibula flap.

In this method, the fibula bone is taken from the leg together with its blood supply and transferred to the jaw region. This allows:

• restoration of jaw continuity
• prevention of facial collapse
• support for speech and eating function
• better control of saliva
• the possibility of future dental implants

For this reason, the fibula flap is one of the strongest bone reconstruction options in head and neck reconstruction.

What Is the Main Goal in These Operations?

The first goal in these operations is, if cancer is present, to eliminate it safely. The next goal is to help the patient enter a safer healing period with fewer complications.

After that, the aims include:

• restoring volume loss
• reducing marked collapse or contour deficiency
• supporting speech and eating function
• reducing salivary leakage and infection
• safely closing open areas that may create life-threatening risk

In other words, head and neck reconstruction is not simply a cosmetic correction; it is a type of surgery that affects quality of life and, in some cases, direct vital safety.

What Makes Your Approach Different in This Field?

One of the most important things that distinguishes me in this field is that I worked for two years in Taiwan with Prof. Fu-Chan Wei, one of the most respected names in this field, at one of the world’s strongest centers for head and neck reconstruction and free tissue transfer.

Prof. Fu-Chan Wei is one of the most influential figures worldwide in the development and widespread adoption of free tissue transfers such as the anterolateral thigh flap and the fibula flap. During the two years I spent at this center, I had the opportunity to observe and perform these operations at a very high volume.

Later, as a university faculty member, I also performed many head and neck reconstruction procedures. This experience gave me a strong technical foundation in microsurgery and head and neck reconstruction.

Another point that supports this is the following: one of the reasons I have focused my aesthetic practice mainly on the face is my deep anatomical knowledge in head and neck reconstruction and facial paralysis surgery. In my practice, aesthetic facial surgery and reconstructive head and neck surgery are not separate worlds; they are two areas that support one another.

What Should the Patient’s Expectations Be?

Because head and neck reconstruction is such a broad field, there is no single expectation for all patients. A patient with a very small cheek defect cannot be considered in the same way as a patient whose entire swallowing pathway has been affected.

For this reason, expectations vary completely according to:

• the cause of the disease
• the extent of the tumor or trauma
• whether nerves are involved
• the type of tissue that has been lost
• the size and complexity of the repair needed

In some patients, only a very limited correction is required, while in others much more complex and staged reconstructions may be necessary. However, in appropriate cases, very strong—and in some situations nearly excellent—functional and aesthetic results can be achieved.

Common Patient Scenarios

I previously had cancer surgery — or in some cases a major trauma — in my jaw area. A tissue transfer was performed, but it did not survive. Only a plate was placed, part of the plate is now visible, I have a clear deformity, and I cannot eat properly. What can be done?

Tissue transfers may fail for different reasons. In some patients, reconstruction may need to be performed again by more experienced hands. In this situation, the old plate can be removed, a new tissue transfer can be performed, and the area can be reconstructed again with a new plate. This may provide both better appearance and better function. If bone reconstruction is needed, a fibula flap can also be used, which may later create the possibility of dental rehabilitation as well.

I had a burn injury in the past, and now I have tight scarring and contractures in my face and neck. My movement is limited. What can be done?

If the contractures are limited, they may sometimes be improved with smaller procedures such as skin grafting or local scar-release techniques like Z-plasty. Supportive treatments such as fat grafting, laser, and similar methods may also help soften the area. However, if the involved area is broad, the contractures are severe, or neck movement and lip position are significantly restricted, then reconstruction with vascularized tissue transfer from another part of the body may be required in order to restore movement and improve contour.

Short FAQs

Is head and neck reconstruction performed only for cancer patients?

No. Although cancer-related defects are one of the most common reasons, it is also required after trauma, burns, and certain severe tissue losses.

Does every patient need free tissue transfer?

No. In small tissue defects, simpler methods may be sufficient. In larger defects or those involving functionally critical areas, free tissue transfer is required.

Why is the fibula flap so important?

Because in patients with loss of the jawbone, it restores bony continuity and also allows future treatments such as dental implants.

Is the goal of these operations only to improve appearance?

No. The goal also includes functional objectives such as speech, eating, saliva control, prevention of infection, and safe healing.

How long should international patients stay in Istanbul?

This depends on the size of the reconstruction to be performed. In smaller and more limited repairs, the stay may be shorter; however, in complex head and neck reconstructions, patients usually need to stay in Istanbul for 3 to 6 weeks. This is important for postoperative monitoring, wound healing, possible additional procedures, and safe discharge planning.

On this page

• Biopsy and diagnosis
• Surgical planning and safe margins
• Lymph node evaluation and dissection
• Simple versus complex reconstruction
• Functional and aesthetic expectations

What Does Skin Cancer Reconstruction Include?

Treatment and reconstruction of skin cancer is one of the main areas of interest in plastic and reconstructive surgery. The most common skin cancers can be broadly divided into three main groups: basal cell carcinoma, squamous cell carcinoma, and malignant melanoma.

Skin cancer reconstruction includes the functional and aesthetic repair of the tissue loss that remains after these cancers are removed. In other words, the goal is not only to clear the cancer, but also to close the resulting defect properly and preserve the function and appearance of the affected area as much as possible.

In Which Areas Is Skin Cancer Most Commonly Seen?

Skin cancers are most commonly seen on the face and in the head and neck region. The main reason is that sunlight is one of the most important risk factors in the development of skin cancer. Since the face and head and neck region are the areas most exposed to the sun, it is not surprising that cancers are seen there more frequently.

The areas we encounter most often are the eyelid, nose, lip, cheek, scalp, and nape of the neck. Many of these areas are sensitive not only aesthetically, but also functionally. For this reason, reconstruction planning after treatment is very important.

How Is Skin Cancer Diagnosed?

Skin cancer is diagnosed by taking a biopsy from a suspicious lesion. The specimen is then examined pathologically, and the type of lesion is clarified based on that evaluation.

The two most important factors in treatment planning are the type of tumor and the extent of the tumor. A small and more limited basal cell carcinoma is not evaluated in the same way as a more aggressive tumor such as malignant melanoma.

How Is Skin Cancer Treatment Planned?

Treatment of skin cancer is usually surgical. The basic principle is removal of the cancerous area with safe surgical margins. Depending on the type of tumor and its risk level, some patients may also require evaluation or removal of lymph nodes.

Once the cancer has been removed, the resulting defect can be reconstructed in the same session. The size and method of this reconstruction vary depending on the size of the tumor, its location, and the depth of the tissue removed.

Today, skin cancers—especially when diagnosed early—are among the cancers that can be treated with great success. However, the most important factors are early diagnosis and proper treatment planning.

In Which Situations Is Simple Closure Enough?

If the tumor is small, diagnosed early, and located in a suitable area, many patients can be treated with a small operation performed under local anesthesia. In such cases, simple closure, small local flaps, or more limited reconstructive methods may be sufficient.

In these patients, the healing process is also faster and more comfortable. Especially in small basal cell carcinomas, the results are often highly successful.

In Which Situations Is More Complex Reconstruction Needed?

If the tumor is larger, more aggressive, or located in a functionally critical area such as the eyelid, nose, or lip, more complex reconstruction may be required.

In particular, in more high-risk tumors such as malignant melanoma, or in cases that create wide loss of skin and soft tissue, more advanced reconstructive techniques may be necessary. In this situation, the goal is not only to close the defect, but also to preserve function and maintain aesthetic balance as much as possible.

In some patients, small local flaps are sufficient, while in larger defects, more advanced reconstructive options may need to be considered.

Why Is More Careful Planning Needed for Skin Cancers of the Face?

The face is an extremely sensitive area, both in terms of appearance and function. Areas such as the nose, eyelid, and lip are not only aesthetically important; they also affect fundamental functions such as protection of the eye, breathing, speech, eating, and lip closure.

For this reason, in reconstruction after facial skin cancer, simply “closing the defect” is not enough. While reconstructing, one must also consider eyelid function, nasal contour and openness, lip function, and facial symmetry.

Successful reconstruction means not only treating the cancer properly, but also achieving the most natural and functional result possible.

Why Is Early Diagnosis Important in Skin Cancer?

Early diagnosis is very important in skin cancer. When the tumor is small, treatment is easier, more limited, and more successful. At the same time, the reconstructive need also remains smaller.

When diagnosis is delayed, the tumor may spread into more tissue, and both treatment and reconstruction become more complex. For this reason, it is important that a suspicious skin lesion be evaluated without delay.

What Should the Patient’s Expectations Be?

In these patients, the primary expectation should first be complete removal of the cancer. The goal of reconstruction is then to bring the functional and aesthetic outcome to the best level possible.

If the tumor is small and detected early, the results are often close to excellent. However, in larger tumors and those diagnosed later, the reconstructive need becomes greater and the process becomes more complex.

In other words, expectations should be shaped according to the size, type, and location of the tumor, as well as the extent of the reconstruction required.

Common Patient Scenarios

A biopsy was taken from a suspicious lesion on my face, and I was diagnosed with basal cell carcinoma. What should happen next?

The main treatment for skin cancer is surgery. Your operation should be planned according to the type of tumor, its extent, and its location. Basal cell carcinoma is a skin cancer with a very low risk of spreading to the lymph nodes, and in most cases it is highly treatable. The important point is to plan the appropriate treatment without unnecessary delay.

I was diagnosed with squamous cell carcinoma, and surgery was recommended. What should I do?

The main treatment for skin cancer is surgery. In squamous cell carcinoma, there is a greater possibility of lymph node involvement compared with basal cell carcinoma. For this reason, depending on the risk profile of the tumor, further evaluation with imaging such as ultrasound or MRI — and in some cases lymph node biopsy or removal — may also be required. The operation should be planned and performed without unnecessary delay. When diagnosed and treated early, surgical results are often very successful.

There is a strong history of skin cancer in my family, and I also have some suspicious skin lesions. What should I do?

If there is a family history of skin cancer — or in some families, a broader history of cancer — you may belong to a higher-risk group. You should protect yourself from the sun carefully and use sunscreen regularly. In addition, any lesion on the face or body that has been present for more than a few months should be evaluated by a dermatologist or a plastic surgeon. If skin cancer is common in your family, regular dermatologic follow-up is also advisable.

I was diagnosed with skin cancer, and my doctor thinks the lymph nodes in my neck may also be involved. What may the treatment process look like?

In this situation, surgery should usually be planned without unnecessary delay. Both the skin cancer itself and the involved lymph nodes may need to be removed. Depending on the size and extent of lymph node involvement, additional treatment such as radiotherapy may also be required. However, the most important step at this stage is timely surgical treatment.

Short FAQs

What is the first step in skin cancer treatment?

The first step is to establish the pathological diagnosis by taking a biopsy from the suspicious lesion.

Does every skin cancer require major surgery?

No. Some small and early-diagnosed lesions can be treated with a relatively limited operation.

Is the goal of skin cancer reconstruction only to improve appearance?

No. The goal is also to preserve the function of areas such as the eyelid, lip, and nose.

On this page

• nerve and vessel injuries of the hand and forearm
• when early repair is important
• delayed reconstruction and muscle transfer
• toe-to-thumb or toe-to-finger transfer in selected cases
• common patient scenarios after hand trauma
• recovery, rehabilitation, and patient expectations

What Does Arm and Hand Nerve–Vessel Repair Include?

This category covers more advanced arm and hand injuries than a simple digital sensory nerve cut. The area in question includes repair of vascular, nerve, muscle, and soft tissue injuries involving the hand, forearm, and arm.

This group includes:

• major nerve injuries
• vascular injuries
• circulatory problems after crush or avulsion injuries
• muscle and soft tissue loss
• late problems that develop after trauma or accidents

In other words, this field refers to advanced repair of nerves, vessels, and soft tissues rather than routine hand surgery.

Which Patients Most Commonly Fall into This Group?

The patients who most commonly fall into this group are those who present because of:

• trauma or accidents
• sharp injuries
• cuts involving nerves and vessels
• crush injuries
• late problems related to these injuries

In some patients, the main issue is sensory loss; in others it is loss of movement; and in others circulatory compromise is the main problem. In some patients, several of these problems are present at the same time. For this reason, every case must be evaluated individually.

What Is the Main Goal Here?

Our main goals in this field are:

• to restore function
• to repair sensation
• to re-establish or strengthen circulation
• to make the patient’s hand and arm more useful in daily life

In some patients, the goal may be full return of movement. In others, achieving a more stable, safer, and more useful arm can still be extremely valuable.

What Distinguishes This Field from Simple Hand Surgery?

What distinguishes this field from more classical hand surgery or more orthopedically oriented approaches is that the main area of interest here is not bone or tendon, but soft tissue, vessel, nerve, and muscle injuries.

The real issues are:

• how the nerve will be repaired
• how the vessel will be connected safely
• how to proceed within scarred or traumatized tissue
• which tissue should be transferred when necessary

These are all based on microsurgical and soft tissue reconstruction principles.

How Does Microsurgery Come into Play Here?

Microsurgery comes into play at many different levels in this field. Some patients need only nerve repair, while others may need nerve grafting, vascular repair, or tissue transfer for soft tissue reconstruction. In later stages, muscle transfer may also become part of treatment.

In other words, this is not simply wound-closure surgery. When necessary, a more advanced reconstructive plan may include:

• nerve grafts
• muscle transfers
• tissue transfers for soft tissue reconstruction

What Is the Most Important Surgical Challenge in These Patients?

The most important surgical challenge in this patient group is having experience in vascular and nerve microsurgery, and especially being able to safely separate tissues within scarred areas.

In previously traumatized or previously operated regions, the anatomy is often distorted. Nerves, vessels, and soft tissues may have deviated from their normal planes. For this reason, in these operations, not only technical knowledge but also command of the tissues and experience in safe dissection are essential.

What Makes Your Approach Different in This Field?

The areas in which I specialize—vascular surgery, nerve surgery, microsurgery, tissue transfer, and peripheral nerve surgery—actually form a common field of soft tissue reconstruction. The same core surgical principles are used in facial paralysis surgery, brachial plexus surgery, and these types of arm and hand nerve–vessel injuries.

In other words, the logic of the surgery I perform here is not separate from the advanced nerve and microsurgical procedures I perform in other regions; it is built on the same fundamental principles.

Another factor that distinguishes me in this field is my intensive surgical practice focused on nerve, vessel, and soft tissue reconstruction together with my microsurgical experience in Taiwan. For me, this area represents more advanced and more specialized cases rather than routine hand surgery.

Do You Still Perform Emergency Finger Replantation Surgery?

Although I have performed many emergency finger replantation surgeries in the past, my current practice is no longer built around routine emergency replantation cases.

My time and focus are now directed more toward:

• complex nerve and vascular injuries
• late problems related to these injuries
• reconstructive procedures and transfers aimed at restoring function

Do You Perform Toe-to-Thumb or Toe-to-Finger Transfer Surgery?

Yes. Because these operations are elective reconstructive procedures and require major experience in microsurgery, nerve repair, and vascular reconstruction, I do perform them in selected patients.

My main priority in this field is function, not appearance alone. For this reason, I consider these procedures especially in patients who are likely to gain meaningful functional benefit — most importantly in thumb reconstruction, and in selected cases of approximately 2–3 cm shortening in other fingers.

These operations are not procedures I perform primarily for cosmetic reasons. Their main purpose is to improve hand function.

In congenital finger deficiencies, the success and indication of this type of surgery are more controversial in the literature. For this reason, I generally prefer these procedures more often in post-traumatic patients rather than in congenital cases.

In appropriate patients, toe-to-thumb or toe-to-finger transfer can be performed successfully, depending on the type and level of the defect. The thumb, the great toe, or the second toe may be considered according to the functional need and the structure of the defect.

In some cases, smaller tissue transfers may also be possible without sacrificing a toe completely — for example in selected nail bed, pulp, or limited fingertip defects. However, these patients must be evaluated individually, and the decision should be made together after detailed examination.

My current practice is focused more on complex nerve–vessel injuries and their late reconstruction.

Is Surgery Still Possible in Old Injuries?

Yes, it is. However, the success rate varies according to the type of injury and the time that has passed.

In some patients with sensory loss, surgery may still be meaningful even at a late stage. In movement loss, however, early intervention is usually more successful, because the chances of achieving improvement through nerve repair or nerve grafting are higher early on.

At a later stage, the nerve alone may no longer be enough, and more advanced methods such as muscle transfer may be needed.

What Should the Patient’s Expectations Be?

The size of the injury, the time that has passed, and which structures are affected directly determine the result.

In some patients, very good recovery of function can be achieved. In others, the goal is not complete return to normal, but a more usable hand, better sensation, or a more stable arm.

Common Patient Scenarios

I cut my finger while cooking, and now part of it feels numb. What should I do?

What has most likely happened is injury to one of the digital sensory nerves of the finger. If this is repaired early — especially within the first week — the quality of recovery is usually better and more predictable. In many patients, this type of surgery can even be performed under local anesthesia. Recovery is usually relatively straightforward, and a small splint may be needed for about 3 weeks.

Even if the repair is delayed, surgery may still be possible years later, and meaningful sensory recovery may still be achieved. However, delayed repair increases the likelihood that a small nerve graft may be required. This may involve either a small nerve taken from the body or, in selected cases, a commercially available nerve graft.

I had a penetrating cut injury. The wound looks small, but I cannot move part of my hand or finger. What could be wrong?

In this situation, the problem may involve tendon, nerve, or muscle injury. Even if the skin wound appears small from the outside, the deeper structures may have been significantly damaged. If movement is lost, surgery is often required. A detailed examination is necessary in order to understand which structures have been injured and what type of repair is needed.

I had a traffic accident and now have a major hand or forearm injury. I cannot perform several movements. What should I do?

In this patient group, detailed examination and, when necessary, imaging studies are used to determine the extent of vessel, nerve, tendon, muscle, and soft tissue injury. In many cases, surgery is planned in order to restore as much function as possible. Depending on the injury, the operation may include repair of skin loss, vessel and nerve injury, tendon problems, and muscle damage.

The most important factors affecting recovery are the severity of the trauma, the time that has passed since the injury, the quality of physical therapy, and the age of the patient. For this reason, after examination, each patient should be clearly informed about what is possible and how much improvement can realistically be expected.

Short FAQs

Can nerves and vessels be repaired in the same operation?

Yes. In suitable cases, nerve, vessel, and soft tissue repair can be planned together in the same surgery.

Is surgery still possible in old injuries?

Yes. However, results may differ in delayed cases, and some patients may require additional procedures such as muscle transfer.

How long does it take for results to appear?

This depends on the procedure performed. In smaller repairs, results may be seen earlier, while in major nerve injuries recovery may take longer.

Is it necessary to work together with orthopedics?

In patients with bone and joint problems, we can plan surgery together with orthopedics. However, in cases requiring repair of vessels, nerves, muscles, tendons, and soft tissues, I perform the intervention.

How important is physical therapy?

Physical therapy is extremely important after these operations and often plays a role that is just as decisive as the surgery itself. The rehabilitation program is adjusted according to the type of procedure performed. For a good result, surgery and rehabilitation must be considered together.

Does every cut nerve or vessel need to be repaired?

No. We do not aim to repair every cut nerve or vessel. Some nerves and vessels may have redundancy and may not create a meaningful problem if left unrepaired. In such cases, unnecessary repair may not always be the best approach. What matters is correctly identifying which structure is truly critical and planning the repair accordingly.

What Is Vascularized Lymph Node Transfer (Lymph Node Transplantation)?

Vascularized lymph node transfer, in other words lymph node transplantation, is a microsurgical treatment method used in patients with lymphedema. In this procedure, lymph nodes with preserved blood circulation are taken from one part of the body and transferred to the lymphedematous area.

The goal is to support lymphatic circulation in the affected region, reduce the risk of infection, and control the progression of swelling.

In Which Patients Does Lymphedema Occur?

Lymphedema is a condition of chronic swelling that develops in the arm, leg, or sometimes the genital region due to disruption of lymphatic circulation. It may be genetic, meaning related to congenital abnormalities of the lymphatic system, and may sometimes appear later in life as well.

It may also develop after cancer surgery involving removal of lymph nodes, or after radiation treatment.

What Are the Main Treatment Options for Lymphedema?

There are essentially four main approaches in the treatment of lymphedema:

• reduction with liposuction
• surgical reduction
• lymphatic bypass surgery
• lymph node transplantation

The same method is not used in every lymphedema patient. The appropriate treatment depends on the stage and duration of the disease, the history of infection, and the treatments that have already been applied.

Is This Procedure Suitable for Every Lymphedema Patient?

No. Lymphedema is a very broad disease group, and the same surgical approach is not appropriate in every patient.

In early-stage lymphedema, physical therapy, bandaging, and compression therapy can be very effective. In some patients, lymphatic bypass surgery may also be appropriate.

In my practice, lymph node transplantation comes to the forefront more often in advanced and resistant lymphedema patients who:

• do not improve despite other treatments
• continue to progress even after lymphatic bypass
• experience frequent infection attacks
• have significant dependence on garments or bandaging

In other words, I do not apply the same treatment to every lymphedema patient; I focus especially on the more resistant patient group who require transplantation.

Why Do You Prefer to Take the Lymph Nodes from the Neck?

The choice of donor site is very important in lymph node transplantation. I most often prefer to harvest lymph nodes from the neck.

The reasons include:

• the high number of lymph nodes in the neck
• the fact that harvesting from this area does not create a risk of lymphedema in the donor site
• the scar below the neck can usually be hidden well

These are important advantages.

This approach may be safer than harvesting lymph nodes from the axilla or groin. It may also offer a more controlled and reliable option than methods in which lymph nodes are taken from inside the abdomen or from around the intestine.

What Does This Operation Aim to Achieve?

The main goals of this operation are:

• to reduce infection attacks
• to stop or slow the progression of swelling
• to reduce dependence on compression garments on a daily and hourly basis
• to improve the effectiveness of physical therapy and lymphatic drainage treatments

The goal is not to eliminate lymphedema completely all at once, but to change the direction of the disease in a more favorable way and improve the patient’s quality of life.

Will Physical Therapy and Lymphatic Drainage Still Be Needed?

Yes, in most patients they still continue. However, the frequency may decrease, and these therapies are expected to become more effective after surgery.

In other words, lymph node transplantation is usually not a miracle procedure on its own, but an important part of a broader treatment plan.

Can This Procedure Be Combined with Other Treatments?

Yes. In suitable patients, lymph node transplantation can be supported with other methods. In particular, combined approaches with liposuction or other supportive methods may provide better results in some patients.

The aim here is not to impose a single method on the patient, but to create the most appropriate combination according to the stage of the disease and the patient’s needs.

What Should Be Expected from the Results?

The main benefits we hope to see after this procedure are:

• a marked reduction in infection attacks
• stopping or slowing the progression of swelling
• reduced dependence on compression garments
• improved quality of life

In some patients, the results can be quite noticeable. In others, improvement may be more gradual and additional treatments may still be needed.

For this reason, expectations must be realistic. However, in the right patient, this operation can make a very meaningful difference.

What Is My Approach in This Field?

As a surgeon working in head and neck reconstruction and microsurgery, I am not someone who tries to treat every type of lymphedema. My approach in this field is to focus specifically on lymph node transplantation surgery in the more resistant patients who have not benefited sufficiently from other methods and who truly require transplantation.

The technique of harvesting lymph nodes from the neck is also an important part of this approach. For me, this area represents not general lymphedema treatment, but a selected field of treatment that requires microsurgical expertise.

Short FAQs

Is it safe to take lymph nodes from the neck?

Yes. When performed with the proper technique, it is a safe method and does not create a risk of lymphedema in the donor area.

Will this operation eliminate the swelling completely?

Not always. However, it is expected to reduce infection attacks, stop or slow the progression of swelling, and provide meaningful improvement in many patients.

Can compression garments or corsets be stopped completely?

It may not be possible in every patient to stop them completely. However, dependence on compression garments usually decreases in terms of both daily duration and overall need.

Will physical therapy and lymphatic drainage still continue?

Yes, in most patients they continue. However, the frequency may decrease, and these therapies are expected to become more effective after surgery.