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Tubed flap reconstruction: rebuilding the throat with skin | CION Cancer Clinics
Tubed flap reconstruction rebuilds the throat using a piece of your own skin and the thin tissue beneath it, rolled into a tube. The skin usually comes from the forearm or thigh, and its small blood vessels are joined to vessels in the neck. It is stitched between the back of the mouth and the food pipe. This page explains the flaps used, the donor site, and who it does not suit. CION Cancer Clinics’ surgical oncologists in Hyderabad can talk this through with you.
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Medically reviewed by Dr. Muralidhar MuddusettyConsultant Surgical Oncologist · MBBS (AIIMS), MS (Surgery, AIIMS), DNB (Surgical Oncology), MRCS (Edinburgh) · last reviewed September 2026, next review due September 2027
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On this page
- What is tubed flap reconstruction of the throat?
- Which flaps are used, and how do they differ?
- How does a flat flap become a new throat?
- What happens to the arm or thigh the flap came from?
- What do families believe about skin flaps that is not true?
- What do the words on the surgical notes mean?
- Who is a tubed skin flap not suitable for?
- Common questions about tubed flap reconstruction
The short answer
What is tubed flap reconstruction of the throat?
A tubed flap rebuilds the throat using a piece of your own skin and the thin tissue under it, rolled into a tube. It is used after the throat has been removed for cancer, and it is stitched between the back of the mouth and the top of the food pipe. The skin usually comes from the forearm or the front of the thigh.
How skin can line a throat
Skin is tough, flexible and heals well. Rolled with the skin side facing inwards, it makes a smooth tube that food can pass through. The flap keeps a small artery and vein, which the surgeon joins to blood vessels in the neck under a microscope so the tissue stays alive.
When it is chosen
It is used when the whole ring of the throat has gone but healthy food pipe remains in the neck. It is also used as a flat patch when only part of the throat wall has been removed. Surgeons often prefer it when avoiding an operation on the abdomen is important.
How it differs from other repairs
A jejunal flap uses small bowel, and a gastric pull-up uses the stomach. A tubed skin flap involves neither the abdomen nor the chest, but the skin does not make its own mucus, so the new throat can feel drier.
Where the tissue comes from
Which flaps are used, and how do they differ?
Your surgeon picks the source based on your build, your earlier treatment and the size of what needs replacing.
Forearm flap
Thin, pliable skin from the inside of the forearm rolls easily into a tube. Before surgery, the team checks the hand has a good blood supply without that artery.
Often called
- Radial forearm free flap
Thigh flap
A larger area of skin from the front and side of the thigh. The scar is easier to hide, but in people with more fat under the skin it can be too thick to roll well.
Often called
- Anterolateral thigh flap
Chest muscle flap
Muscle and skin from the chest are swung up into the neck while still attached to their own blood supply, so no microscope join is needed. It is bulkier and is often used to patch or reinforce.
Often called
- Pectoralis major flap
Not sure whether this applies to you?
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How does a flat flap become a new throat?
The flap is raised
While the cancer is removed from the neck, a second team lifts the skin and tissue from the arm or thigh, keeping its small artery and vein.
It is rolled into a tube
The flap is stitched along its length, skin side inwards, to form a tube the width of a throat.
The blood vessels are joined
Under a microscope, the flap's artery and vein are joined to vessels in the neck, and blood flow is checked.
The tube is stitched in place
The top is joined to the back of the mouth and the bottom to the food pipe. A feeding tube lets the joins heal before you swallow.
The other wound
What happens to the arm or thigh the flap came from?
The place the flap is taken from is called the donor site. It heals separately from the neck, and for many people it is the wound they notice most in the first weeks.
After a forearm flap
The forearm usually cannot be closed directly, so a thin skin graft, often from the thigh, covers the area. The arm is kept in a splint at first so the graft can take. Stiffness, numbness over part of the hand and a visible patch on the forearm are common. Hand exercises from a physiotherapist help.
After a thigh flap
The thigh can often be stitched closed in a straight line. The front of the thigh may feel numb, and walking can feel tight for a while. Most people are encouraged to walk early.
After a chest muscle flap
There is a scar on the chest, and the shoulder on that side may feel weaker when pushing or lifting. For women, the flap can change the shape of the breast on that side. Ask about this beforehand.
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Commonly believed
What do families believe about skin flaps that is not true?
"Hair will grow inside his throat."
Forearm skin in most people has little hair. Surgeons choose areas with less hair, and hair growth usually stops after radiotherapy. If it causes trouble, it can be treated.
"He will lose the use of his arm."
The hand's blood supply is tested before the forearm flap is taken. Stiffness and numbness are common early, but most people regain good use of the hand with exercises.
"Skin is a second-rate replacement for a real throat."
No repair is the same as the original throat. A skin flap is a well-established option, and many people speak clearly with a voice valve after it.
"If the join leaks, the operation has failed."
A leak along the seam or at a join is a known problem. Many heal with feeding by tube, wound care and time, without another operation. Some need further surgery.
On your report
What do the words on the surgical notes mean?
- Free flap
- Tissue fully detached and moved, with its blood vessels joined to new ones at the neck.
- Pedicled flap
- Tissue swung into place while still attached to its original blood supply, like the chest muscle flap.
- Donor site
- The place the flap was taken from, such as the forearm or thigh.
- Skin graft
- A thin shaving of skin used to cover the donor site when it cannot be stitched closed.
- Salivary bypass tube
- A soft tube sometimes placed inside the new throat for a while, to keep saliva away from the healing joins.
Being straight with you
Who is a tubed skin flap not suitable for?
A tubed flap needs healthy food pipe in the neck to join to. If the cancer reaches down into the chest, a gastric pull-up is usually used instead.
When the flap source is a problem
A forearm flap is not taken if the hand depends on that artery. A thigh flap may be too thick to roll in people with more fat under the skin. A free flap needs healthy neck blood vessels, and heavy earlier radiotherapy or neck surgery can leave too few. A chest muscle flap is then often the fallback.
What this page cannot tell you
It cannot tell you which flap your surgeon will use, how your swallowing and voice will turn out, or what your own risk of a leak is. Ask why this flap was chosen, where it will come from, and what happens if it does not take.
Questions we are asked
Common questions about tubed flap reconstruction
Is a tubed flap better than a jejunal flap?
Neither is better for everyone. A skin flap avoids an operation on the abdomen and often gives a clearer valve voice. A jejunal flap gives a moist lining and a natural tube. Your surgeon chooses based on your body, earlier treatment and their own experience.
Which arm will they take the flap from?
Usually the arm you use less, so a right-handed person often has the flap taken from the left forearm. The team checks the blood supply to that hand first. Tell them which hand you use for work and daily tasks.
Will the donor scar be very visible?
A forearm donor site leaves a noticeable patch where the skin graft sits, which fades but does not disappear. A thigh scar is a long line that clothing usually covers. Ask to see photographs of healed donor sites if that would help you prepare.
Why does my new throat feel dry?
Skin does not make mucus the way the throat lining did, and radiotherapy can reduce saliva too. Sipping water with meals, moist foods and sauces all help. A swallowing therapist can suggest other ways to make eating more comfortable.
What is a leak along the flap?
Saliva escaping through a gap in the seam or a join, usually showing as fluid or redness in the neck wound. It is called a fistula. Many heal with tube feeding and wound care. Tell the team straight away if the neck swells or leaks.
Can I speak with a voice valve after a skin flap?
Many people can, and the voice is often clear. A small valve between the windpipe and the new throat lets air vibrate the tissue. Whether it is placed during the operation or later is decided by your surgeon and speech therapist.
What if food starts to stick later on?
The lower join can narrow as it heals, so food sticks or needs washing down. This is usually treated by stretching the join with a scope. Because sticking can also mean the cancer has returned, always tell your team rather than waiting.
Is this reconstruction covered by Aarogyasri or insurance?
Head and neck cancer surgery with reconstruction is usually covered under Aarogyasri, CGHS, ECHS, EHS and most cashless insurance policies, subject to approval and cover limits. Call the helpline with your card or policy details and we will check before admission.
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Sources
- National Cancer Institute — Hypopharyngeal cancer treatment (PDQ), patient version
- American Cancer Society — Laryngeal and hypopharyngeal cancer
- Macmillan Cancer Support — Head and neck cancer
- Cancer Research UK — Laryngeal cancer
This page is general information, not a prescription. Do not change or stop any treatment based on what you read here. If anything is worrying you, contact your own treating team — or call our helpline and we will help you reach the right specialist.
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Send us the scans and the surgical plan, or call the helpline. A surgical oncologist will explain which flap is proposed and why. One helpline serves every CION centre.