About Your Mandibulectomy and Fibula Free Flap Reconstruction

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Time to Read: About 35 minutes

This guide will help you get ready for your mandibulectomy (MAN-dih-bul-EK-toh-mee) at MSK. It will also help you know what to expect as you recover.

Use this guide as a source of information in the days leading up to your surgery. Bring it with you on the day of your surgery. You and your care team will use it as you learn more about your recovery.

About your mandibulectomy and fibula free flap reconstruction

Mandibulectomy and free-flap reconstruction

A mandibulectomy is a surgery to remove all or part of your jaw (mandible). You may have a mandibulectomy if you have a tumor that affects your jaw.

Your jaw may be rebuilt using bone from another part of your body (the donor site). The bone may be taken from your fibula, which is the smaller of the 2 bones in your lower leg. An artery, vein, and soft tissue will also be removed with the bone. This is called a fibula free flap (see Figure 1).

Figure 1. Fibula free flap

Figure 1. Fibula free flap

Most jaw reconstructions use the leg as the donor site. Some surgeries rebuild your jaw using a bone from a different donor site or do not use bone in your reconstruction. Your plastic surgeon will talk with you about how they’ll rebuild your jaw.

You may also need a skin graft to cover your donor site. A skin graft is made by taking the top layer of skin from one part of your body. It’s moved to the surgical site that must be covered. Often, the skin graft is taken from the thigh. Your plastic surgeon will talk with you about the plan for your surgery.

Before your surgery

You’ll meet with your head and neck surgeon, your plastic surgeon, and your dentist. They’ll make sure it’s safe for you to have surgery. They’ll also take computed tomography (CT) scan(s) and X-rays to assess the amount of tumor in your jaw. These images will be used to make a model of your new jaw before surgery.

You may also have:

  • Photographs taken of your face to use during the reconstruction.
  • An angiogram, a scan that uses special dye to take images of the blood vessels in your donor site. An angiogram can use X-rays, magnetic resonance angiography, or CT angiography to evaluate blood vessels.

During your surgery

Your surgery will be done by 3 surgical teams. There will be a head and neck team, a plastics team, and dental team.

Your head and neck surgeon will remove the tumor from your jaw and the soft tissue around it. At the same time, your plastic surgeon will remove the bone, tissue, and skin from your donor site. This will take 3 to 4 hours.

Your head and neck surgeon will send the tumor and surrounding tissue to the Pathology Department for testing. Once your head and neck surgeon has completed their part of the surgery, reconstruction can start.

Your plastic surgeon will transfer the tissue from your donor site and use it to reconstruct your jaw. They will shape the bone from your donor site. Their goal is to closely match the part of your jaw that was removed.

Next, your plastic surgeon will take the artery and vein from the donor site. They will attach it to an artery and vein in your head and neck area. This is done under a microscope.

They will keep the new jawbone in place with plates and screws. They will cover it with the soft tissue. Your plastic surgeon will then place stitches in your face and neck to connect them to the soft tissue. The reconstruction part of the surgery usually takes 6 to 8 hours.

During your reconstruction, your dentist may place temporary arch bars and rubber bands in your mouth (see Figure 2). These will keep your teeth and jaw correctly aligned. Your dentist will remove the rubber bands 5 to 7 days after your surgery. They will take out the arch bars 14 days after your surgery. 

Figure 2. Arch bars and rubber bands

Figure 2. Arch bars and rubber bands

Mandibulectomy can cause swelling and make it hard to breathe. To prevent this, you will have a tracheostomy (TRAY-kee-OS-toh-mee). This is a procedure to make an opening in your trachea (windpipe) while you’re still asleep. They will put a tracheostomy tube through the opening in your neck into your trachea. This will keep your airway open and make it easier for you to breathe.

Your surgery will also cause facial swelling. This will affect the way you eat, drink, and talk. This will slowly improve as the area heals over several months.

During your surgery, a nasogastric (NG) tube will be put through your nose into your stomach. The NG tube will help you get nutrients for the first 1 to 2 weeks while your jaw is healing.

After your jaw heals, the NG tube will be removed. You will slowly start to eat and drink again. Your doctor will decide when it’s safe to do so. How long this will take is different for each person. It also depends on the amount of surgery you had. Tell your care team if you have any questions or concerns.

Before your mandibulectomy and fibula free flap reconstruction

This section will help you get ready for your surgery. Read it when your surgery is scheduled. Refer to it as your surgery gets closer. It has important information about what to do to get ready.

As you read this section, write down questions to ask your healthcare provider.

Getting ready for your surgery

You and your care team will work together to get ready for your surgery. Help us keep you safe by telling us if any of these things apply to you, even if you’re not sure.

  • I take an anticoagulant (blood thinner), such as:
    These are examples of medicines. There are others.

    Be sure your healthcare provider knows all the medicines you’re taking.
    • Aspirin
    • Heparin
    • Warfarin (Jantoven®, Coumadin®)
    • Clopidogrel (Plavix®)
    • Enoxaparin (Lovenox®)
    • Dabigatran (Pradaxa®)
    • Apixaban (Eliquis®)
    • Rivaroxaban (Xarelto®)
  • I take an SGLT2 inhibitor, such as:
    • Canagliflozin (Invokana®)
    • Dapagliflozin (Farxiga®)
    • Empagliflozin (Jardiance®)
    • Ertugliflozin (Steglatro®)
  • I take prescription medicine(s), including patches and creams. A prescription medicine is one you can only get with a prescription from your healthcare provider.
  • I take over-the-counter medicine(s), including patches and creams. An over-the-counter medicine is one you can buy without a prescription.
  • I take dietary supplements, such as herbs, vitamins, minerals, or natural or home remedies.
  • I have a pacemaker, automatic implantable cardioverter-defibrillator (AICD), or other heart device.
  • I have sleep apnea.
  • I have had a problem with anesthesia (A-nes-THEE-zhuh) in the past. Anesthesia is medicine to make you sleep during a surgery or procedure.
  • I’m allergic to certain medicines or materials, including latex.
  • I’m not willing to receive a blood transfusion.
  • I drink alcohol.
  • I smoke or use an electronic smoking device, such as a vape pen or e-cigarette.
  • I use recreational drugs, such as marijuana.

About drinking alcohol

It’s important to talk with your healthcare providers about how much alcohol you drink. This will help us plan your care.

If you drink alcohol regularly, you may be at risk for problems during and after your surgery. These include bleeding, infections, heart problems, and a longer hospital stay.

If you drink alcohol regularly and stop suddenly, it can cause seizures, delirium, and death. If we know you’re at risk for these problems, we can prescribe medicine to help prevent them.

Here are things you can do before your surgery to keep from having problems.

  • Be honest with your healthcare providers about how much alcohol you drink.
  • Try to stop drinking alcohol once your surgery is planned. Tell your healthcare provider right away if you:
    • Get a headache.
    • Feel nauseous (like you’re going to throw up).
    • Feel more anxious (nervous or worried) than usual.
    • Cannot sleep.

These are early signs of alcohol withdrawal and can be treated.

  • Tell your healthcare provider if you cannot stop drinking.
  • Ask your healthcare provider questions about drinking and surgery. All your medical information will be kept private, as always.

About smoking

If you smoke, you can have breathing problems when you have surgery. Stopping for even a few days before your surgery can help.

Your healthcare provider will refer you to our Tobacco Treatment Program if you smoke. You can also reach the program by calling 212-610-0507.

About sleep apnea

Sleep apnea is a common breathing problem. If you have sleep apnea, you stop breathing for short lengths of time while you’re asleep. The most common type is obstructive sleep apnea (OSA). With OSA, your airway becomes fully blocked during sleep.

OSA can cause serious problems during and after surgery. Tell us if you have or think you might have sleep apnea. If you use a breathing device, such as a CPAP machine, bring it on the day of your surgery.

Using MyMSK

MyMSK (my.mskcc.org) is your MSK patient portal. You can use it to send and read messages from your care team, view your test results, see your appointment dates and times, and more. You can also invite your caregiver to make their own account so they can see information about your care.

If you do not have a MyMSK account, you can sign up at my.mskcc.org. You can get an enrollment ID by calling 646-227-2593 or your doctor’s office.

Watch How to Enroll in MyMSK: Memorial Sloan Kettering's Patient Portal to learn more. You can also contact the MyMSK Help Desk by emailing [email protected] or calling 800-248-0593.

About Enhanced Recovery After Surgery (ERAS)

ERAS is a program to help you get better faster after your surgery. It’s important to do certain things before and after your surgery as part of the ERAS program.

Before your surgery, make sure you’re ready by:

  • Reading this guide. It will help you know what to expect before, during, and after your surgery. If you have questions, write them down. You can ask your healthcare provider at your next visit or call their office.
  • Exercising and following a healthy diet. This will help get your body ready for your surgery.

After your surgery, help yourself recover more quickly by:

  • Reading your recovery pathway. This is an educational resource your healthcare provider will give you. It has goals for your recovery. It will help you know what to do and expect each day.
  • Starting to move around as soon as you can. The sooner you get out of bed and walk, the quicker you can get back to your usual activities.

Within 30 days of your surgery

Presurgical testing (PST)

You’ll have a PST appointment before your surgery. You’ll get a reminder from your surgeon’s office with the appointment date, time, and location.

You can eat and take your usual medicine(s) the day of your PST appointment.

It’s helpful to bring these things to your appointment:

  • A list of all the medicines you’re taking, including prescription and over-the-counter medicines, patches, and creams.
  • Results of any medical tests done outside of MSK in the past year, if you have them. Examples include results from a cardiac stress test, echocardiogram, or carotid doppler study.
  • The names and telephone numbers of your healthcare providers.

You’ll meet with an advance practice provider (APP) during your PST appointment. They work closely with MSK’s anesthesiology (A-nes-THEE-zee-AH-loh-jee) staff. These are doctors with special training in using anesthesia during a surgery or procedure.

Your APP will review your medical and surgical history with you. You may have tests to plan your care, such as:

  • An electrocardiogram (EKG) to check your heart rhythm.
  • A chest X-ray.
  • Blood tests.

Your APP may recommend you see other healthcare providers. They’ll also talk with you about which medicine(s) to take the morning of your surgery.

Identify your caregiver

Your caregiver has an important role in your care. Before your surgery, you and your caregiver will learn about your surgery from your healthcare providers. After your surgery, your caregiver will take you home when you’re discharged. They’ll also help you care for yourself at home.

For caregivers

‌  Caring for a person going through cancer treatment comes with many responsibilities. We offer resources and support to help you manage them. Visit www.msk.org/caregivers or read A Guide for Caregivers to learn more.

Fill out a Health Care Proxy form

If you have not already filled out a Health Care Proxy form, we recommend you do now. If you already filled one out or have any other advance directives, bring them to your next appointment.

A health care proxy is a legal document. It says who will speak for you if you cannot communicate for yourself. This person is called your health care agent.

Talk with a member of your care team if you have questions about filling out a Health Care Proxy form.

Do physical activity

Doing physical activity will help your body get into its best condition for your surgery. It will also make your recovery faster and easier.

Try to do physical activity every day. Any activity that makes your heart beat faster, such as walking, swimming, or biking, is a good choice. If it’s cold outside, use stairs in your home or go to a mall or shopping center.

Follow a healthy diet

Follow a well-balanced, healthy diet before your surgery. If you need help with your diet, talk with your healthcare provider about meeting with a clinical dietitian nutritionist.

Buy a 4% chlorhexidine gluconate (CHG) solution antiseptic skin cleanser, such as Hibiclens®

4% CHG solution is a skin cleanser that kills germs for 24 hours after you use it. Showering with it before your surgery will help lower your risk of infection after surgery. You can buy a 4% CHG solution antiseptic skin cleanser at your local pharmacy without a prescription.

7 days before your surgery

Follow your healthcare provider’s instructions for taking aspirin

Aspirin can cause bleeding. If you take aspirin or a medicine that has aspirin, you may need to change your dose or stop taking it 7 days before your surgery. Follow your healthcare provider’s instructions. Do not stop taking aspirin unless they tell you to.

To learn more, read How To Check if a Medicine or Supplement Has Aspirin, Other NSAIDs, Vitamin E, or Fish Oil

Stop taking vitamin E, multivitamins, herbal remedies, and other dietary supplements

Vitamin E, multivitamins, herbal remedies, and other dietary supplements can cause bleeding. Stop taking them 7 days before your surgery. If your healthcare provider gives you other instructions, follow those instead.

To learn more, read Herbal Remedies and Cancer Treatment.

2 days before your surgery

Stop taking nonsteroidal anti-inflammatory drugs (NSAIDs)

NSAIDs, such as ibuprofen (Advil® and Motrin®) and naproxen (Aleve®), can cause bleeding. Stop taking them 2 days before your surgery. If your healthcare provider gives you other instructions, follow those instead.

To learn more, read How To Check if a Medicine or Supplement Has Aspirin, Other NSAIDs, Vitamin E, or Fish Oil.

1 day before your surgery

Note the time of your surgery

A staff member will call you after the day before your surgery. If your surgery is scheduled for a Monday, they’ll call you the Friday before. If you do not get a call by , call 212-639-5014.

The staff member will tell you what time to get to the hospital for your surgery. They’ll also remind you where to go.

This will be the following location:

The Presurgical Center (PSC) at Memorial Hospital
1275 York Ave. (between East 67th and East 68th streets)
New York, NY 10065
Take the B elevator to the 6th floor.

Shower with a 4% CHG solution antiseptic skin cleanser, such as Hibiclens

Shower with a 4% CHG solution antiseptic skin cleanser before you go to bed the night before your surgery.

  1. Wash your hair with your usual shampoo and conditioner. Rinse your head well.
  2. Wash your face and genital (groin) area with your usual soap. Rinse your body well with warm water.
  3. Open the 4% CHG solution bottle. Pour some into your hand or a clean washcloth.
  4. Move away from the shower stream. Rub the 4% CHG solution gently over your body from your neck to your feet. Do not put it on your face or genital area.
  5. Move back into the shower stream to rinse off the 4% CHG solution. Use warm water.
  6. Dry yourself off with a clean towel.

Do not put on any lotion, cream, deodorant, makeup, powder, perfume, or cologne after your shower.

Instructions for eating and drinking: 8 hours before your arrival time

  • Stop eating 8 hours before your arrival time, if you have not already. 
    • Your healthcare provider may tell you to stop eating earlier. If they do, follow their instructions.
  • 8 hours before your arrival time, do not eat or drink anything except these clear liquids:
    • Water.
    • Soda.
    • Clear juices, such as lemonade, apple, and cranberry juices. Do not drink orange juice or juices with pulp.
    • Black coffee or tea (without any type of milk or creamer).
    • Sports drinks, such as Gatorade®.
    • Gelatin, such as Jell-O®.
    You can keep having these until 2 hours before your arrival time.

The morning of your surgery

Instructions for drinking: 2 hours before your arrival time

 Stop drinking 2 hours before your arrival time. This includes water.

Take your medicines as instructed

A member of your care team will tell you which medicines to take the morning of your surgery. Take only those medicines with a sip of water. Depending on what you usually take, this may be all, some, or none of your usual morning medicines.

Shower with a 4% CHG solution antiseptic skin cleanser, such as Hibiclens

Shower with a 4% CHG solution antiseptic skin cleanser before you leave for the hospital. Use it the same way you did the night before.

Do not put on any lotion, cream, deodorant, makeup, powder, perfume, or cologne after your shower.

Things to remember

  • Wear something comfortable and loose-fitting.
  • If you wear contact lenses, wear your glasses instead. Wearing contact lenses during surgery can damage your eyes.
  • Do not wear any metal objects. Take off all jewelry, including body piercings. The tools used during your surgery can cause burns if they touch metal.
  • Leave valuable items at home.
  • If you’re menstruating (have your monthly period), use a sanitary pad, not a tampon. We’ll give you disposable underwear and a pad if you need them.

What to bring

  • Your breathing device for sleep apnea (such as your CPAP machine), if you have one.
  • Your Health Care Proxy form and other advance directives, if you filled them out.
  • Your cell phone and charger.
  • Only the money you may want for small purchases, such as a newspaper.
  • A case for your personal items, if you have any. Eyeglasses, hearing aids, dentures, prosthetic devices, wigs, and religious articles are examples of personal devices.
  • This guide. You’ll use it to learn how to care for yourself after surgery.

Where to park

MSK’s parking garage is on East 66th Street between York and 1st avenues. If you have questions about prices, call 212-639-2338.

To get to the garage, turn onto East 66th Street from York Avenue. The garage is about a quarter of a block in from York Avenue. It’s on the right (north) side of the street. There’s a tunnel you can walk through that connects the garage to the hospital.

There are other parking garages on:

  • East 69th Street between 1st and 2nd avenues.
  • East 67th Street between York and 1st avenues.
  • East 65th Street between 1st and 2nd avenues.

Once you’re in the hospital

When you get to the hospital, take the B elevator to the 6th floor. Check in at the desk in the PSC waiting room.

Many staff members will ask you to say and spell your name and birth date. This is for your safety. People with the same or a similar name may be having surgery on the same day.

We’ll give you a hospital gown, robe, and nonskid socks to wear when it’s time to change for surgery.

Meet with a nurse

You’ll meet with a nurse before surgery. Tell them the dose of any medicines you took after midnight (12 a.m.) and the time you took them. Make sure to include prescription and over-the-counter medicines, patches, and creams.

Your nurse may place an intravenous (IV) line in one of your veins, usually in your arm or hand. If your nurse does not place the IV, your anesthesiologist (A-nes-THEE-zee-AH-loh-jist) will do it in the operating room.

Meet with an anesthesiologist

You’ll also meet with an anesthesiologist before surgery. They will:

  • Review your medical history with you.
  • Ask if you’ve had any problems with anesthesia in the past. This includes nausea (feeling like you’re going to throw up) or pain.
  • Talk with you about your comfort and safety during your surgery.
  • Talk with you about the kind of anesthesia you’ll get.
  • Answer questions you have about anesthesia.

Get ready for surgery

When it’s time for your surgery, you’ll take off your eyeglasses, hearing aids, dentures, prosthetic devices, wig, and religious articles.

You’ll either walk into the operating room or a staff member will bring you there on a stretcher. A member of the operating room team will help you onto the operating bed. They’ll put compression boots on your lower legs. These gently inflate and deflate to help blood flow in your legs.

Once you’re comfortable, your anesthesiologist will give you anesthesia through your IV line and you’ll fall asleep. You’ll also get fluids through your IV line during and after your surgery.

During your surgery

After you’re fully asleep, your care team will place a breathing tube through your mouth into your airway. It will help you breathe. They’ll also place a urinary (Foley) catheter in your bladder. It will drain your urine (pee) during your surgery.

Your surgeon will close your incisions with staples or stitches once they finish your surgery.

Your care team will usually take out your breathing tube while you’re still in the operating room.

After your mandibulectomy and fibula free flap reconstruction

In the Post-Anesthesia Care Unit (PACU)

You’ll be in the PACU when you wake up after your surgery. A nurse will be keeping track of your temperature, pulse, blood pressure, and oxygen levels. You may get oxygen through a tube resting below your nose or a mask over your nose and mouth. You’ll also have compression boots on your lower legs.

You may not be able to open your mouth because of the rubber bands. You will not be able to talk because a tracheostomy tube will be in your windpipe. Your nurses will ask you “yes” or “no” questions about how you feel. You’ll be given an iPad to help you answer these questions. They will give you a dry erase board so you can write down what you need. 

Pain medication

You’ll get IV pain medicine while you’re in the PACU. It will be put into your bloodstream through your IV line.

You’ll be able to control your pain medication using a button called a patient-controlled analgesia (PCA) device. Read Patient-Controlled Analgesia (PCA) to learn more 

Tubes and drains

You’ll have tubes, drains, catheters (thin, flexible tubes), and other medical devices, including:

  • A humidifier collar placed over your tracheostomy tube. It will send moist air to your lungs.
  • An IV line that will let you have fluids, antibiotics, pain medication, and anticoagulants to prevent blood clots.
  • A urinary (Foley) catheter to drain urine from your bladder. It will be removed 2 or 3 days after your surgery.
  • Drains (small tubes) in your neck and your donor site to let fluid drain. They’ll be removed when the drainage is less than 1 ounce in 24 hours.
  • A feeding tube that goes through your nose into your stomach. This is called a nasogastric (NG) tube. You’ll get high-protein liquid feedings and some of your medications through this tube. You will not be able to eat and drink until the swelling from the surgery goes down.
  • A cast, splint, sling, or wound VAC may be placed on the donor site. A wound VAC is a special dressing that applies suction to your wound to improve healing.  It will be removed 5 to 7 days after your surgery. If you have a cast, splint, or sling, a dressing will be placed underneath it.
  • Compression boots on 1 or both legs. This helps circulate blood to prevent blood clots. If your donor site was on one of your legs, that leg will not have a boot on it.

For the first week after your surgery, your doctors and nurses will monitor the blood supply to your jaw and nearby tissue. They’ll use a machine called a Doppler®. It’s noisy, but painless. It will be used every hour for the first 2 days after your surgery.

After 2 days, your doctor will decide how often to use the Doppler. Your doctor and nurse will check that the flap feels warm to touch. They will check it has color that’s like the skin around it.

It’s very important to avoid any pressure on your newly built jaw. You will not be able to use a pillow while you’re in the hospital.

Your nurses and nursing assistants will care for your drains, tubes, and tracheostomy. As you start to feel better, they’ll teach you how to do some of this care yourself. 

Moving to your hospital room

You may stay in the PACU for a few hours or overnight. How long you stay depends on the type of surgery you had. A staff member will bring you to your hospital room after your stay in the PACU. 

In your hospital room

The length of time you’re in the hospital after your surgery depends on your recovery. Most people stay in the hospital for 10 to 14 days.

In your hospital room, you’ll meet one of the nurses who will care for you during your stay. A nurse will help you out of bed and into your chair soon after you get there.

Your care team will teach you how to care for yourself while you’re healing from your surgery. You can help yourself recover more quickly by:

  • Reading your recovery pathway. We will give you a pathway with goals for your recovery if you do not already have one. It will help you know what to do and expect on each day during your recovery.
  • Starting to move around as soon as you can. The sooner you get out of bed and walk, the quicker you can get back to your normal activities.

Suctioning the tracheostomy tube

When you cough and breathe deeply, there’s mucus from your lungs and the back of your throat. The mucus will come through your tracheostomy tube and must be suctioned. Your nurse will do this often during the first few days after your surgery. They will then also teach you how to do it yourself. To learn more, read Caring for Your Tracheostomy.

Once the swelling goes down, you’ll have less mucus. The opening of the tracheostomy tube will be capped so you can breathe through your nose. They will remove the tube once you can breathe normally and cough up mucus comfortably with the tracheostomy tube capped.

If you go home with the tracheostomy tube in place, your nurse will teach you how to care for it. We’ll order a portable suctioning machine for you.

Managing your pain

You’ll have some pain after your surgery. At first, you’ll get your pain medication through your IV line. You’ll be able to control your pain medication using a PCA device. Once you can eat, you’ll get oral pain medication (medicine you swallow) through a feeding tube. You can get it by mouth once you can swallow.

We will ask you about your pain often and give you medication as needed. Tell one of your healthcare providers if your pain is not better. Controlling your pain can help you recover faster.

You’ll get a prescription for pain medication before you leave the hospital. Talk with your healthcare provider about possible side effects. Ask them when to start switching to over-the-counter pain medication.  

Irrigating your mouth

Irrigating (wetting) you mouth will start 5 days after your surgery or as soon as your rubber bands are removed. Your nurse will start wetting your mouth with salt water and baking soda. This helps keep your mouth clean and moist.

You’ll keep irrigating your mouth after you leave the hospital. Do this 3 to 4 times a day, in the morning, after meals, and at bedtime. Your nurse will give you an irrigation kit to take home with you. 

Preventing trismus (lockjaw)

Trismus is when you have trouble opening your mouth. It can develop after surgery or radiation therapy. It’s caused by soft tissue scarring or changes in the muscles around the jaw. You must do jaw exercises to prevent trismus. As soon as you’re ready, your doctor or nurse will tell you how often to do them.

To learn more, read Managing Trismus After Treatment for Head and Neck Cancer.  

Moving around and walking

Moving around and walking will help lower your risk for blood clots and pneumonia (lung infection). It will also help you start passing gas and having bowel movements (pooping) again. Your nurse, physical therapist, or occupational therapist will help you move around, if needed.

To learn more about how walking can help you recover, read Frequently Asked Questions About Walking After Your Surgery

To learn what you can do to stay safe and keep from falling while you’re in the hospital, read Call! Don't Fall!

Eating and drinking

Your nurse will give you tube feedings through your NG tube for the first 1 to 2 weeks. Once the swelling starts to go down, they will take out your NG tube. You will get clear liquids to drink and then soft foods to eat. How soon this happens will depend on how you heal.

If you have questions about your diet, ask to see a clinical dietitian nutritionist.

Caring for your donor site

The leg is the most common donor site for jaw reconstructions. If you had a different donor site for your new jaw, your nurse will tell you how to care for it.

You’ll stay in bed for the first 2 days after your surgery to help your leg heal. After 2 days, you can get out of bed and sit in a chair with your leg raised. It’s important to keep your leg raised as much as possible for the first 3 weeks. This will help with swelling and healing.

Your doctor will tell you when you can start walking again. You’ll need to use a walker at first. You’ll be able to walk on your own over time.

In the hospital, your nurse will tell you how to care for your leg and skin graft. When it’s time to go home, they’ll give you more instructions, if you still need them.  

Planning for discharge

Your care team will work with the Case Manager to set up any equipment or home care you will need when you get home. 

Leaving the hospital

Before you leave, look at your incision with one of your healthcare providers. Knowing what it looks like will help you notice any changes later.

On the day of your discharge, plan to leave the hospital around Your healthcare provider will write your discharge order and prescriptions before you leave. You’ll also get written discharge instructions. One of your healthcare providers will review them with you before you leave.

If your ride isn’t at the hospital when you’re ready to leave, you may be able to wait in the Patient Transition Lounge. A member of your care team will give you more information. 

Read What You Can Do to Avoid Falling to learn what you can do to keep from falling at home and during your appointments at MSK.

Filling out your Recovery Tracker

We want to know how you’re feeling after you leave the hospital. To help us care for you, we’ll send questions to your MyMSK account. We’ll send them every day for 10 days after you’re discharged. These questions are known as your Recovery Tracker.

Fill out your Recovery Tracker every day before midnight (12 a.m.). It only takes 2 to 3 minutes to complete. Your answers to these questions will help us understand how you’re feeling and what you need.

Based on your answers, we may reach out to you for more information. Sometimes, we may ask you to call your surgeon’s office. You can always contact your surgeon’s office if you have any questions.

To learn more, read About Your Recovery Tracker.

Managing your pain

People have pain or discomfort for different lengths of time. You may still have some pain when you go home and will probably be taking pain medication. Some people have soreness, tightness, or muscle aches around their incision for 6 months or longer. This doesn’t mean something is wrong.

Follow these guidelines to help manage your pain at home.

  • Take your medicines as directed and as needed.
  • Call your healthcare provider if the medicine prescribed for you does not help your pain.
  • Do not drive or drink alcohol while you’re taking prescription pain medicine. Some prescription pain medicines can make you drowsy (very sleepy). Alcohol can make the drowsiness worse.
  • You’ll have less pain and need less pain medicine as your incision heals. An over-the-counter pain reliever will help with aches and discomfort. Acetaminophen (Tylenol®) and ibuprofen (Advil or Motrin) are examples of over-the-counter pain relievers.
    • Follow your healthcare provider’s instructions for stopping your prescription pain medicine.
    • Do not take too much of any medicine. Follow the instructions on the label or from your healthcare provider.
    • Read the labels on all the medicines you’re taking. This is very important if you’re taking acetaminophen. Acetaminophen is an ingredient in many over-the-counter and prescription medicines. Taking too much can harm your liver. Do not take more than one medicine that has acetaminophen without talking with a member of your care team.
  • Pain medicine should help you get back to your usual activities. Take enough to do your activities and exercises comfortably. You may have a little more pain as you start to be more active.
  • Keep track of when you take your pain medicine. It works best 30 to 45 minutes after you take it. Taking it when you first have pain is better than waiting for the pain to get worse.

Some prescription pain medicines, such as opioids, may cause constipation. Constipation is when you poop less often than usual, have a harder time pooping, or both.

Preventing and managing constipation

Talk with your healthcare provider about how to prevent and manage constipation. You can also follow these guidelines.

  • Go to the bathroom at the same time every day. Your body will get used to going at that time. But if you feel like you need to go, don’t put it off.
  • Try to use the bathroom 5 to 15 minutes after meals. After breakfast is a good time to go. That’s when the reflexes in your colon are strongest.
  • Exercise, if you can. Walking is a great type of exercise that can help prevent and manage constipation.
  • Drink 8 to 10 (8-ounce) cups (2 liters) of liquids daily, if you can. Choose water, juices (such as prune juice), soups, and milkshakes. Limit liquids with caffeine, such as coffee and soda. Caffeine can pull fluid out of your body.
  • Slowly increase the fiber in your diet to 25 to 35 grams per day. Unpeeled fruits and vegetables, whole grains, and cereals contain fiber. If you have an ostomy or recently had bowel surgery, ask your healthcare provider before changing your diet.
  • Both over-the-counter and prescription medicines can treat constipation. Ask your healthcare provider before taking any medicine for constipation. This is very important if you have an ostomy or have had bowel surgery. Follow the instructions on the label or from your healthcare provider. Examples of over-the-counter medicines for constipation are:
    • Docusate sodium (Colace®). This is a stool softener (medicine that makes your bowel movements softer) that causes few side effects. You can use it to help prevent constipation. Do not take it with mineral oil.
    • Polyethylene glycol (MiraLAX®). This is a laxative (medicine that causes bowel movements) that causes few side effects. Take it with 8 ounces (1 cup) of a liquid. Only take it if you’re already constipated.
    • Senna (Senokot®). This is a stimulant laxative, which can cause cramping. It’s best to take it at bedtime. Only take it if you’re already constipated.
    If any of these medicines cause diarrhea (loose, watery bowel movements), stop taking them. You can start again if you need to.

Caring for your incision

If you have stitches inside of your mouth, they’ll dissolve on their own. They do not need to be removed.

Your doctor will remove the stitches in your face and neck about 2 weeks after your surgery. If you had radiation therapy to your face or neck, stitches may stay in place for 3 to 4 weeks.

  • Do not apply heat or cold right on your incisions. You may numb or burn yourself.
  • Do not use hot water bottles or heating pads. You should also avoid saunas and steam rooms.
  • Do not shave over your incisions while your stitches are in place. If you shave your face or neck, use an electric shaver.
  • Do not use perfume, cologne, after-shave, or perfumed moisturizers until your incisions are completely healed.
  • Avoid sun exposure. Wait until your head and neck surgeon decides your incisions are completely healed. Then you can use a PABA-free sunscreen with an SPF of 30 or higher on your incisions.

Call your healthcare provider’s office if:

  • The skin around your incision is very red or getting more red.
  • The skin around your incision is warmer than usual.
  • The area around your incision is starting to swell or getting more swollen.
  • You see drainage that looks like pus (thick and milky).
  • Your incision smells bad. 

Showering

You can shower when you go home after surgery. Keep your leg dry to avoid wetting your skin graft. Do not swim until your care team says your incisions are healed. Avoid hot tubs, baths, and swimming pools until then.

Eating and drinking

Most people must follow a puréed diet after they’re discharged (leave the hospital). This means food must be put through a blender or food processor. Your dietitian will go over this diet with you. Your diet will change as you heal.

To learn more, read Eating Guide for Puréed Food and Mechanical Soft Food Diets

If you have questions about your diet, ask to see a clinical dietitian nutritionist.  

Physical activity and exercise

Your incision may look like it’s healed on the outside when you leave the hospital. It will not be healed on the inside. For the first 6 weeks after your surgery:

  • Do not lift anything heavier than 5 pounds (2.3 kilograms).
  • Do not do any high-energy activities, such as jogging and tennis.
  • Do not play any contact sports, such as football.

Talk with your healthcare provider before returning to activities such as lifting and exercise.

It’s common to have less energy than usual after surgery. Recovery time is different for everyone. Do more activity each day as much as you can. Always balance activity periods with rest periods. Rest is an important part of your recovery.

Sexual Activity

Your healthcare provider will tell you when you can start sexual activity again.

Driving

Your healthcare provider will tell you when you can start driving again. This will depend on the extent of your surgery and how quickly you recover.

Do not drive while you’re taking pain medication that may make you drowsy.

You can ride in a car as a passenger at any time after you leave the hospital.

Going back to work

Talk with your healthcare provider about your job. They’ll tell you when it may be safe for you to start working again based on what you do. If you move around a lot or lift heavy objects, you may need to stay out a little longer. If you sit at a desk, you may be able to go back sooner.

Follow-up appointments

Your first appointment after surgery will be 7 to 10 days after you leave the hospital. Your nurse will give you instructions on how to make this appointment, including the phone number to call.

Test results

Test results are often ready in 10 to 14 days. Your doctor will talk with you about your results during your first follow-up appointment after your surgery.  

Managing your feelings

You may have new and upsetting feelings after a surgery for a serious illness. Many people say they felt weepy, sad, worried, nervous, irritable, or angry at one time or another. You may find that you cannot control some of these feelings. If this happens, it’s a good idea to seek emotional support. Your healthcare provider can refer you to MSK’s Counseling Center. You can also reach them by calling 646-888-0200.

The first step in coping is to talk about how you feel. Family and friends can help. We can also reassure, support, and guide you. It’s always a good idea to let us know how you, your family, and your friends are feeling emotionally. Many resources are available to you and your family. We’re here to help you and your family and friends handle the emotional aspects of your illness. We can help no matter if you’re in the hospital or at home.

When to call your healthcare provider

Call your healthcare provider if:

  • You have a fever of 100.5 °F (38 °C) or higher.
  • You have chills.
  • You’re having trouble breathing.
  • The skin around your incision is very red or getting more red.
  • The skin around your incision is warmer than usual.
  • The area around your incision is starting to swell or getting more swollen.
  • You see drainage that looks like pus (thick and milky).
  • Your incision smells bad. 
  • You have any questions or concerns.

Contact information

If you have questions or concerns, contact your healthcare provider. A member of your care team will answer Monday through Friday from to Outside those hours, you can leave a message or talk with another MSK provider. There is always a doctor or nurse on call.

If you’re not sure how to reach your healthcare provider, call 212-639-2000.

Support services

This section has a list of support services. They may help you as you get ready for your surgery and recover after your surgery.

As you read this section, write down questions to ask your healthcare provider.

MSK support services

Admitting Office
212-639-7606
Call if you have questions about your hospital admission, such as asking for a private room.

Anesthesia
212-639-6840
Call if you have questions about anesthesia.

Blood Donor Room
212-639-7643
Call for information if you’re interested in donating blood or platelets.

Bobst International Center
332-699-7968
We welcome patients from around the world and offer many services to help. If you’re an international patient, call for help arranging your care.

Counseling Center
www.msk.org/counseling
646-888-0200
Many people find that counseling helps them. Our Counseling Center offers counseling for individuals, couples, families, and groups. We can also prescribe medicine to help if you feel anxious or depressed. Ask a member of your care team for a referral or call the number above to make an appointment.

Food Pantry Program
646-888-8055
We give food to people in need during their cancer treatment. Talk with a member of your care team or call the number above to learn more.

Integrative Medicine Service
www.msk.org/integrativemedicine
Our Integrative Medicine Service offers many services to complement (go along with) traditional medical care. For example, we offer music therapy, mind/body therapies, dance and movement therapy, yoga, and touch therapy. Call 646-449-1010 to make an appointment for these services.

You can also schedule a consultation with a healthcare provider in the Integrative Medicine Service. They’ll work with you to make a plan for creating a healthy lifestyle and managing side effects. Call 646-608-8550 to make an appointment for a consultation.

MSK Library
library.mskcc.org
212-639-7439
You can visit our library website or call to talk with the library reference staff. They can help you find more information about a type of cancer. You can also visit the library’s Patient and Health Care Consumer Education Guide.

Nutrition Services
www.msk.org/nutrition
212-639-7312
Our Nutrition Service offers nutritional counseling with one of our clinical dietitian nutritionists. Your clinical dietitian nutritionist will talk with you about your eating habits. They can also give advice on what to eat during and after treatment. Ask a member of your care team for a referral or call the number above to make an appointment.

Patient and Community Education
www.msk.org/pe
Visit our patient and community education website to search for educational resources, videos, and online programs.

Patient Billing
646-227-3378
Call if you have questions about preauthorization with your insurance company. This is also called preapproval.

Patient Representative Office
212-639-7202
Call if you have questions about the Health Care Proxy form or concerns about your care.

Perioperative Nurse Liaison
212-639-5935
Call if you have questions about MSK releasing any information while you’re having surgery.

Private Duty Nurses and Companions
917-862-6373
You can request private nurses or companions to care for you in the hospital and at home. Call to learn more.

Rehabilitation Services 
www.msk.org/rehabilitation 
Cancers and cancer treatments can make your body feel weak, stiff, or tight. Some can cause lymphedema (swelling). Our physiatrists (rehabilitation medicine doctors), occupational therapists (OTs), and physical therapists (PTs) can help you get back to your usual activities.

  • Rehabilitation medicine doctors diagnose and treat problems that affect how you move and do activities. They can design and help coordinate your rehabilitation therapy program, either at MSK or somewhere closer to home. Call Rehabilitation Medicine (Physiatry) at 646-888-1929 to learn more.
  • An OT can help if you’re having trouble doing usual daily activities. For example, they can recommend tools to help make daily tasks easier. A PT can teach you exercises to help build strength and flexibility. Call Rehabilitation Therapy at 646-888-1900 to learn more.

Resources for Life After Cancer (RLAC) Program
646-888-8106
At MSK, care does not end after your treatment. The RLAC Program is for patients and their families who have finished treatment.

This program has many services. We offer seminars, workshops, support groups, and counseling on life after treatment. We can also help with insurance and employment issues.

Sexual Health Programs
Cancer and cancer treatments can affect your sexual health, fertility, or both. MSK’s sexual health programs can help you before, during, or after your treatment.

Social Work
www.msk.org/socialwork
212-639-7020
Social workers help patients, families, and friends deal with common issues for people who have cancer. They provide individual counseling and support groups throughout your treatment. They can help you communicate with children and other family members.

Our social workers can also help refer you to community agencies and programs. If you’re having trouble paying your bills, they also have information about financial resources. Call the number above to learn more.

Spiritual Care
212-639-5982
Our chaplains (spiritual counselors) are available to listen, help support family members, and pray. They can contact community clergy or faith groups, or simply be a comforting companion and a spiritual presence. Anyone can ask for spiritual support. You do not have to have a religious affiliation (connection to a religion).

MSK’s interfaith chapel is located near Memorial Hospital’s main lobby. It’s open 24 hours a day. If you have an emergency, call 212-639-2000. Ask for the chaplain on call.

Tobacco Treatment Program
www.msk.org/tobacco
212-610-0507
If you want to quit smoking, MSK has specialists who can help. Call to learn more.

Virtual Programs
www.msk.org/vp
We offer online education and support for patients and caregivers. These are live sessions where you can talk or just listen. You can learn about your diagnosis, what to expect during treatment, and how to prepare for your cancer care.

Sessions are private, free, and led by experts. Visit our website to learn more about Virtual Programs or to register.

External support services

Access-A-Ride
web.mta.info/nyct/paratran/guide.htm
877-337-2017
In New York City, the MTA offers a shared ride, door-to-door service for people with disabilities who can’t take the public bus or subway.

Air Charity Network
www.aircharitynetwork.org
877-621-7177
Provides travel to treatment centers.

American Cancer Society (ACS)
www.cancer.org
800-ACS-2345 (800-227-2345)
Offers a variety of information and services, including Hope Lodge, a free place for patients and caregivers to stay during cancer treatment.

Cancer and Careers
www.cancerandcareers.org
646-929-8032
A resource for education, tools, and events for employees with cancer.

CancerCare
www.cancercare.org
800-813-4673
275 Seventh Avenue (Between West 25th & 26th Streets)
New York, NY 10001
Provides counseling, support groups, educational workshops, publications, and financial assistance.

Cancer Support Community
www.cancersupportcommunity.org
Provides support and education to people affected by cancer.

Caregiver Action Network
www.caregiveraction.org
800-896-3650
Provides education and support for people who care for loved ones with a chronic illness or disability.

Corporate Angel Network
www.corpangelnetwork.org
866-328-1313
Offers free travel to treatment across the country using empty seats on corporate jets.

Good Days
www.mygooddays.org
877-968-7233
Offers financial assistance to pay for copayments during treatment. Patients must have medical insurance, meet the income criteria, and be prescribed medicine that’s part of the Good Days formulary.

HealthWell Foundation
www.healthwellfoundation.org
800-675-8416
Provides financial assistance to cover copayments, health care premiums, and deductibles for certain medicines and therapies.

Joe’s House
www.joeshouse.org
877-563-7468
Provides a list of places to stay near treatment centers for people with cancer and their families.

LGBT Cancer Project
www.lgbtcancer.com
Provides support and advocacy for the LGBT community, including online support groups and a database of LGBT-friendly clinical trials.

LIVESTRONG Fertility
www.livestrong.org/we-can-help/fertility-services
855-744-7777
Provides reproductive information and support to cancer patients and survivors whose medical treatments have risks associated with infertility.

Look Good Feel Better Program
www.lookgoodfeelbetter.org
800-395-LOOK (800-395-5665)
This program offers workshops to learn things you can do to help you feel better about your appearance. For more information or to sign up for a workshop, call the number above or visit the program’s website.

National Cancer Institute
www.cancer.gov
800-4-CANCER (800-422-6237)

National LGBT Cancer Network
www.cancer-network.org
Provides education, training, and advocacy for LGBT cancer survivors and those at risk.

Needy Meds
www.needymeds.org
Lists Patient Assistance Programs for brand and generic name medicines.

NYRx
www.health.ny.gov/health_care/medicaid/program/pharmacy.htm
Provides prescription benefits to eligible employees and retirees of public sector employers in New York State.

Patient Access Network (PAN) Foundation
www.panfoundation.org
866-316-7263
Gives help with copayments for patients with insurance.

Patient Advocate Foundation
www.patientadvocate.org
800-532-5274
Provides access to care, financial assistance, insurance assistance, job retention assistance, and access to the national underinsured resource directory.

Professional Prescription Advice
www.pparx.org
888-477-2669
Helps qualifying patients without prescription drug coverage get free or low-cost medicines.

Red Door Community (formerly known as Gilda’s Club)
www.reddoorcommunity.org
212-647-9700
A place where people living with cancer find social and emotional support through networking, workshops, lectures, and social activities.

RxHope
www.rxhope.com
877-267-0517
Provides assistance to help people get medicines they have trouble affording.

Triage Cancer
www.triagecancer.org
Provides legal, medical, and financial information and resources for cancer patients and their caregivers.

Educational resources

This section lists the educational resources mentioned in this guide. They will help you get ready for your surgery and recover after your surgery.

As you read these resources, write down questions to ask your healthcare provider.

Last Updated

Monday, March 11, 2024

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