Free Flap Surgery: Procedure, Alternatives, Benefits, and Risks

What is Free Flap?

Free flap surgery is a method to reconstruct a skin/muscle or a bone defect caused by injury. disease or an operation; by using microvascular techniques.

Rectus Abdominis (Abdomen)

Temporoparietal Fascial Flap (Scalp)

Gracilis Muscle (Thigh)

What Are the Alternatives to This Procedure?

In today’s time and age, free flaps are the best option for reconstruction of complex tissue defects, where expertise for such procedures is available. In certain situations, free flaps can be the only option available while at other times it may be possible to transfer tissues from nearby areas to cover the defect. These options will vary from patients to patient, and depends on the site of the tissue defect. You can discuss about the available options with your surgeon at the time of the consultation.

How to Get Prepared for the Surgery?

Your surgeon will give you instructions regarding preparation for the surgery. These will include guidelines on

– Tobacco use you will be required to stop tobacco consumption in any form for atleast three weeks prior to a surgery.

– Blood thinning medications must be stopped for about 7 days prior to surgery.

What Happens During the Surgery?

The surgery involves surgically cleaning the wound at site of ulcer/tumor. A flap (composite tissue) taken from some other healthier area as indicated by your doctor is harvested along with its vessels. The flap is applied on the wound/defect to be reconstructed and the blood supply to the flap is restored by joining the blood vessels to blood vessels near the recipient site (original wound) using a microscope and microsutures. The donor area (the place from where flap is harvested) is either closed if small or covered with skin graft harvested from thigh. The flap after the surgery is monitored frequently to ensure that it is healthy. It takes about 1 week after surgery to confidently declare success of flap surgery

 Commonly used flaps and donor areas for free flap

Antero Lateral Thigh flap (Thigh)

Radial Forearm Flap (Forearm)

Fibula Flap (Leg)

Lateral Arm Flap (Arm)

Abdomen Omental Flap (From inside abdomen)

Latissimus Dorsi Flap (Back)

Parascapular Flap (Back)

What Happens After the Surgery?

You may be kept in the ICU or in Post-Operative ward for a day or two. During this period you and the flap will be monitored intensively. Later, you will be shifted to another room but regular monitoring of the flap will continue for 5-7 days. If the post-operative period is uneventful, you are likely to get discharged in 5-7 days time.Minimal donor site morbidity High success rate among experienced surgeons What are the general risks of having an operation? These have been mentioned in the “Anesthesia Consent Form.” Please discuss this with your Anesthetist before signing the Anesthesia Consent Form.

What are the Risks of this Procedure?

While majority of patients have an uneventful surgery and recovery, few cases may be associated with complications. These are seen infrequently and not all the ones listed below are applicable to one individual. However it is important that you are aware of the complications/risks that may arise out of this procedure which are as below: Note: The listed risks and complications are not all inclusive Recipient Area Excessive bleeding or blockage of blood supply to the flap which may require re-operation Loss/Blackening of part or whole of the flap Loss of skin graft on recipient area Pus/Blood accumulation under the flap Recurrence of tumor in case of resection of tumor as primary cause Persistence of sinuses around the healed flap because of persistence of deep infection Re-operation in case of any sign of congestion (Blockage in blood supply in the flap) or excessive bleeding Scars, contour deformities 

What are the Benefits of this Procedure?

This technique is used in a number of reconstructive procedures including mandilubar, breast, and facial reconstruction. Some benefits of this procedure include:

Stable wound coverage

Improved aesthetic and functional outcomes

Minimal donor site morbidity

High success rate among experienced surgeons

What are the General Risks of Having an Operation?

These have been mentioned in the “Anesthesia Consent Form.” Please discuss this with your Anesthetist before signing the Anesthesia Consent Form.

What Are the Risks of this Procedure?

While majority of patients have an uneventful surgery and recovery, few cases may be associated with complications. These are seen infrequently and not all the ones listed below are applicable to one individual. However it is important that you are aware of the complications/risks that may arise out of this procedure which are as below: Note: The listed risks and complications are not all inclusive

Recipient Area

Excessive bleeding or blockage of blood supply to the flap which may require re-operation

Loss/Blackening of part or whole of the flap

Loss of skin graft on recipient area

– Pus/Blood accumulation under the flap

Recurrence of tumor in case of resection of tumor as primary cause

Persistence of sinuses around the healed flap because of persistence of deep infection

Re-operation in case of any sign of congestion (Blockage in blood supply in the flap) or excessive bleeding

Scars, contour deformities CS CamSca FREE FLAP PROCEDURE

Donor Area

Dehiscence of wound if closed during primary procedure

Loss of skin graft

Exposure of deeper structure requiring extra procedures for reconstruction

Scars, contour deformities