The terms free flap and free tissue transfer are synonymous labels used to describe the movement of tissue from one site on the body to another. "Free" implies that the tissue, along with its blood supply, is detached from the original location ("donor site") and then transferred to another location ("recipient site"). This is in contrast to a "pedicled" flap in which tissue is left attached to the donor site and simply transposed to a new location keeping the "pedicle" intact as a conduit to supply the tissue with blood. Various types of tissue may be transferred as a free flap including skin and fat, muscle, nerve, bone, or any combination of these. An example of the latter would be a "free toe transfer" in which the 1st or 2nd toe is transferred to the hand to reconstruct a thumb. For all free flaps, the blood supply is reconstituted using microsurgery to reconnect the artery (blood into the flap) and vein (allows blood to flow out of the flap). The free flap requires microsurgical techniques and is utilised during reconstructive surgery.
Free flaps may be done for a number of reasons, including:
Free flaps all have common steps. These do not necessarily occur in order.
The most common serious complication of a free flap is loss of the venous outflow (e.g. a clot forms in the vein that drains the blood from the flap). Loss of arterial supply is serious too and both will cause necrosis (death) of the flap. Close monitoring of the flap both by nurses and by the surgeon is important postoperatively. If caught early, loss of either the venous or arterial blood supply may be corrected. Many times an implantable doppler probe or other devices can be installed during surgery to provide better monitoring in the postoperativ period. The doppler probe can be removed before discharge from the hospital.
Usually donor sites are selected which will cause the least amount of disability but some disability may occur. Other complications which may occur with any surgery are also possible including infection and pain.
Free flaps can be very complex and lengthy surgeries. Length commonly ranges from 6 to 12 hours but can take longer based on the complexity.
Finger and hand reattachments use the same microvascular techniques.
The suture used to reattach blood vessels is made of nylon.
Many successful free flap surgeries are performed every day.
MANDIBULAR RECONSTRUCTION WITH FROZEN AUTOLOGOUS MANDIBULAR BONE AND RADIAL PERIOSTEAL FASCIOCUTANEOUS FREE FLAP: PRELIMINARY REPORT
Dec 01, 2004; The authors present a new method of mandibular reconstruction with frozen autologous mandibular bone. Vascular supply to the...
Lateral upper arm free flap for primary reconstruction of pharyngeal defects in ablative oncological surgery: Report of six consecutive cases
Jul 01, 2003; Free microvascular flaps are an established method for soft tissue reconstruction following ablative oncological surgery in the...