Free Flaps (Hand & Leg Cover)

What is Free Flap Surgery?

The free flap surgery or the autologous tissue transfer and microvascular free tissue transfer is synonymous term are used to describe the tissue transplantation from one area of the body to another, in order to reconstruct an existing defect.

The free flap surgery is usually performed by the disconnection of the tissue, which is also termed free flap from its original blood supply and further moved a significant distance to be reconnected to a new blood supply. The free flap surgery is mainly performed to reconstruct an existing defect and a widely used cosmetic procedure in the plastic and cosmetic surgery fraternity.

There are various types of tissue may be transferred as a free flap including skin and fat, muscle, nerve, bone, cartilage, lymph nodes and intestinal segments. The most common example of free flap surgery is “free toe transfer” in which great toe transfer or the second toe is transferred to reconstruct the thumb.

Flap Surgery

Micro vascular Head & Neck Reconstruction:

Usually, the micro vascular head and neck reconstruction technique are applied to reconstruct face and neck by using blood vessels, bone and tissue, including muscle and skin from other parts of the body. This is the most advanced surgical technique that rehabilitating the surgical defects that are caused by the removal of head and neck tumours.

The Technique of Free Flap Surgery:

The free flap surgery is done by the initiation of the harvesting process in which a flap of healthy tissue is harvested from the areas where it is not as important, i.e., remote sites in the body with the blood supply and further transferred to the areas where the wound is affected. However, the wound area is recipient site and the remote areas from where the tissue with blood vessels has been harvested are known as the donor area. Thus, the tissue transfer in the free flap surgery is also a two-way process in which donor, as well as recipient areas, is required to fulfil the need for free flap surgery.

Local Flap vs. Free Flaps

Flaps are classified according to their complexity and this is the job of the surgeon to choose least complex flaps in order to achieve the desired success in the free flap surgery and this concept is known as the reconstructive ladder. Free flap surgery is the most innovative technique in the plastic & cosmetic surgery in which any type of tissue is transferred from the donor site where it is possible to harvest with the intact blood supply and further moved to the site where the defect is predominant. However, the free flap surgery involves the tissue transfer from one part of the body to another and a two-way process between the donor and the recipient sites. The free flap surgery is done to fill a defect caused by the wound, injury or surgery when the remaining tissue is unable to support a graft or to rebuild more complex anatomic structure such as jaw or breast.

1. Local Flaps: Local flaps are created by freeing a layer of the tissue and the stretched to fill up the defects. This is the least complex type of flap, which includes advancement flaps, rotation flaps, and transposition flaps respectively in increasing order of the complexities of the flaps. The incision is made to harvest the flap tissue and stretching the same in order to fill the respective wounded areas on the recipient site. The blood supply remains intact even after the harvesting and thus allow the recipient site to adopt the growth process of new blood vessels.

2. Regional Flaps: Regional flaps are not immediately adjacent to the defect and thus the free tissue, which is termed as the island is moved over or underneath normal tissue to reach the defect to be filled. The blood supply is still connected to the donor site via a pedicle. The pedicle can be removed later on after the formation of a new blood supply.
3. Distant Flaps: Distant flaps are used when the donor site is far from the defects. The distant flaps are considered as one of the most complex types of the flap. This allows the blood supply from the donor site while the new blood supply forms on the recipient site where the defect is predominated. Free flap surgery involves the blood supply cut, which is reattached microsurgically to a new blood supply at the recipient site.
   

How Free flap Surgery can be done?

The Steps involved in the free flap surgery is jotted down below:

1. A defect is created surgically either by removing the tumour or following the cleansing of wounds
2. An incision is made on the donor site from where the flap is needed to be harvested
3. The flap is dissected and freed from the surrounding tissue
4. The vascular pedicle, which constitutes one vein and artery are dissected
5. The flap is separated from rest of the body following the dividing of vein and artery
6. before pedicle is divided the recipient area of the wound or injury, defects are identified where a flap is going to re-attached
7. The free flap is brought to defect areas and the vein and artery from the flap are anastomosed or re-connected to the vein and artery of the identified wound. This re-connection is done by using a microscope or loop, hence it is known as Microsurgery.
8. The free flap is sutured to defect.
9. The donor site gets closed. In some particular case, the skin grafts may be performed and placed on the top of the donor site or the defect site.

How Much Does Free flap Surgery cost?

The free flap surgery is considered as a Gold standard technique for the head and neck reconstruction. It is the complex surgical procedure which requires extreme surgical sense; proper training in the microsurgery and the high-end equipment is needed to perform the procedure with the utmost aesthetic outcome. The Medispa plastic & cosmetic surgery clinic allow you to receive the microsurgery of the free flap with the expert hand of Dr Suneet Soni at an affordable cost in Jaipur, Delhi, Kota and Dubai.

The cost of free flap surgery can be determined by the following Factors:

• Surgical skills of the surgeon
• Training and experience of the surgeon
• The elevated equipment cost used in the surgery
• Surgical devices
• Recognition of the plastic & cosmetic surgery centre.