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As one of the country鈥檚 largest hospitals, surgeons at University Hospital Southampton carry out over 34,000 operations every year, many of which are the last hope for their patients.

Maxillofacial consultant Sanjay Sharma takes on some of the most challenging cases involving the face, jaw and mouth. Sanjay originally operated on sixty-seven-year-old Sue three years ago to remove cancer and to reconstruct her jaw. However, subsequent radiotherapy caused her to develop a rare condition that damaged blood vessels and caused the bone in the reconstruction to die. Sue鈥檚 jaw has started to crumble, resulting in infections and a loss of function, including difficulty eating and speaking. Sanjay now faces the challenging task of rebuilding Sue鈥檚 jaw once again.

The procedure is so extensive that Sanjay will be joined in theatre by three other surgeons. As Sanjay removes dead bone and tissue from the jaw, plastic surgeon Nigel Horlock will work on Sue鈥檚 leg, cutting a skin flap and section of fibula bone to form the new facial reconstruction. Because the blood vessels in Sue鈥檚 neck have been damaged, the surgeons also need to create a new blood supply to Sue鈥檚 face by harvesting an alternative blood vessel. This will be connected to her mammary artery and then tunnelled underneath the skin to reach the neck, where it will be connected to the flap鈥檚 vein and artery. When problems develop with the blood flow, Sue鈥檚 reconstruction hangs in the balance.

Challenging operations at Southampton also include complex gastrointestinal surgery, and Professor Tim Underwood specialises in these procedures. His patient, 67-year-old Monique, requires an oesophagectomy, as she has advanced cancer in her oesophagus, or swallowing tube.

To potentially cure Monique, Tim will need to remove the cancerous section of her oesophagus and then repurpose her stomach to create a new swallowing tube. But taking out the oesophagus is not straightforward; the section where the cancer sits is stuck to the aorta, the body鈥檚 biggest blood vessel, and also the pericardium, the membrane surrounding the heart. Damaging either could have fatal consequences. Even if Tim manages to free and remove the cancerous section of oesophagus, he must still successfully shape the stomach into a new swallowing tube by stapling it, pulling it up into the chest and connecting it to the remaining top end of the oesophagus in Monique鈥檚 neck.