A free tissue transplant or “free flap” is a swath of tissue from the arm, back, chest, abdomen, or leg that includes skin, soft tissue, sometime muscle and even bone, as well as specific blood vessels (artery and vein) and sometimes nerves that has been surgically removed from one part of the body, total removed, and transplanted to another part of the body by utilizing microsurgery to connect the small blood vessels (artery and vein) under the magnification of an operating microscope. This tissue is more than just a skin graft. It will also contain blood vessels and frequently muscle that can be utilized to heal the area where it is transplanted.
A free tissue transplant is sometimes the best reconstructive option that a patient may decide to undergo in order to restore form and function to an injured part of the body or to correct a disfigurement.
Who needs a free flap?
Free tissue transplants are used to repair wounds or disfigurements that involve deeper tissue than just the skin. These can be caused by trauma or by disease, such as diabetes or cancer. Dr. Boynton will tell you if your wound(s) merit this type of surgery and will discuss all options with you.
Description of Free Flap Surgery
Free tissue transplantation (“free flap” surgery) is performed in hospital, and the surgery is done under general anesthesia. Sometimes this type of surgery can be extremely lengthy, even up to 9-12 hours in some cases. Most patients stay in the hospital for 4-5 days as an inpatient. Dr. Boynton will choose to take tissue from a part of your body that is best suited for the part of the body which needs the transplant. For example, a transplant on the hand will require different kind of tissue than a transplant on the face. The healthy tissue is carefully dissected from the donor area of your body, so as to minimize any donor deficits. This healthy tissue is then inset into the wound and the blood vessels are connected using the techniques of microsurgery and a special operating microscope. The donor and transplant sites will be bandaged, and you may have to wear a dressing on a larger area in order to help hold the tissue in place during the healing process.
Recovery After Free Flap Reconstruction
You will need someone to drive them home after their hospital stay, and you will probably need help around the house for awhile. If the transplant took place on your arm or leg, for example, you may need help with household tasks during the entire healing process. Dr. Boynton will monitor your progress during follow-up visits, and you will be instructed how to wash and change your dressings. You may not be able to bathe for a few days, and you will experience some swelling, bruising, numbness, and pain during the healing process.
Dr. Boynton will let you know if elevating the affected area is advised. You will also be given prescriptions for pain medication and an antibiotic. The amount of time it takes to heal varies from patient to patient. It may be several months before you will be able to see the final results of your surgery. Physical therapy may also be necessary to restore proper movement, especially if muscle has been transplanted.
Surgical Risks
Free flap surgery is highly complex surgery that is often done by “teams” usually consisting of one or two plastic surgeons that have advanced training in “microsurgery”, which is the surgical discipline of sewing together very small blood vessels under the microscope in order to reestablish the blood supply to the flap. Free flaps can fail and if they do, sometimes a second flap has to be performed. Because the surgery is lengthy and the hospital stay is more lengthy, there is some degree of increased risks that can be seen in any surgery such as bleeding, infection, blood clots, etc.
Schedule a Consultation for Free Flap Surgery
Dr. James F. Boynton can meet with you for an initial consultation to talk about all aspects of free flap reconstruction surgery. Please contact our practice for more information.
