Free Flap Surgeries

Overview -

Free flap surgery, also known as free tissue transfer, is a reconstructive treatment that involves moving skin from one place of the body to another. A large vein or artery is still attached to the transplanted tissue. To connect the transplanted tissue to a damaged area, a graft or flap is employed. The "flap" might be nothing more than fatty tissues. It might also contain muscle from the area where the tissue was removed. Free flap surgery, also known as free tissue transfer, is a reconstructive treatment that involves moving skin from one place of the body to another. A large vein or artery is still attached to the transplanted tissue. To connect the transplanted tissue to a damaged area, a graft or flap is employed. The "flap" might be nothing more than fatty tissues. It may also contain muscle from the area where the tissue was removed.

Why it’s done -

In most cases, surgeons try to maintain incisions parallel to existing skin to reduce scarring and make it simpler for tissues to recover after removing a tumour and other afflicted tissues. However, if there is severe tissue loss, skin from another place may be required to rectify the defect and restore function and attractiveness.

Surgery Procedure -

The free flap must be monitored during the postoperative phase to ensure flap survival. When detected early and treated quickly (within 6 hours), damaged flaps have a 75 percent chance of being saved when returned to the operation room. Ischemia tolerance is better in adipocutaneous flaps than in musculocutaneous flaps. Venous thrombosis is more prevalent than either arterial or mixed arterial and venous thrombosis, according to studies. In 80 percent of patients, thrombosis develops during the first two days. As a result, all workers in charge of flap monitoring must understand the appearance and evaluation of healthy and damaged flaps. The following are some more things to keep in mind:

• As soon as a flap compromise is detected, send the patient to the operating room for further investigation.

• Give heparin intravenously.

• Examine the vascular pedicle for kinks and compression, as well as the anastomosis for patency.

• To identify the thrombus, the vessels at the anastomosis must be separated.

• Using a number 2 or 3 Fogarty catheter, do embolectomy proximally and distally.

• If necessary, inject intra-arterial streptokinase or urokinase at a dosage of 50,000-100,000 U.

• Inset the flap again if enough circulation has been restored, and keep the patient on intravenous heparin or dextran.

• If enough circulation is not restored, the flap must be removed.

• Hirudo medicinalis, or medicinal leeches, have been shown to be effective in the treatment of venous congestion. When arterial inflow is acceptable but venous outflow is inadequate, this approach is recommended. The active chemical generated by the leeches, hirudin, which is a specific thrombin inhibitor, is responsible for the mechanism of action. To inhibit leech migration, apply the leech to the flap's surface and surround it with a corral of damp gauze. To avoid infection with Aeromonas hydrophila, prophylactic medications are indicated.

Risk and Complications -

General surgical hazards such as infection are possible complications of flap surgery.

• scarring and/or discoloration of the skin

• a hematoma or profuse bleeding

• necrosis of the skin or fat (tissue death)

• Wound separation or inadequate wound healing

• clots in the blood

• The dangers of anesthesia

• thrombosis of the deep veins

• problems of the heart and lungs

• edema (swelling) or fluid collection that persists

• chronic discomfort

• lack of cutaneous feeling (temporary or permanent)

• poor aesthetic outcomes that necessitate revision surgery

• The expander breaking or leaking

If you feel chest discomfort, shortness of breath, irregular heartbeats, or heavy bleeding, call your surgeon right once.

Do’s and Don’ts after Free Flap :

• Only use antibiotics and pain relievers as directed by our doctor at Medipulse.

• Take no aspirin or anti-inflammatory medications for two weeks before and after surgery unless your surgeon has given you permission. For simple processes, this may not be an essential necessity. If you're unsure, consult a Specialist at Medipulse.

• If the incision starts to bleed, simply apply firm pressure to the region for 15 to 20 minutes.

• Allow no drying or crust development in the incisions. Keeping the region moist with the aforementioned treatments will expedite healing and provide you with the best scar possible.

• For the first 48 hours after surgery, sleeping with your head elevated may help reduce any swelling.

• For several weeks following the procedure, you should expect some numbness in the flap region. This numbness can sometimes last for weeks or months.

• Massage, rub or apply pressure to any incisions for at least 4 weeks after surgery.

• Do not remove the bandage if a skin graft has been utilized until you have been examined in the office.

Insurance Covered – Following insurances are covered for CRIF :

The average length of stay - entails 6-7 days in hospital & 4-8 weeks to fully recover

Doctors who perform Free Flap Surgery