Micro-Vascular
Free Tissue Transfer (syn. free flap surgery)
Microsurgery is that surgical speciality that requires magnification
for its completion. Microsurgery covers many surgical specialities
including plastic surgery, ophthalmology, neurosurgery,
ENT surgery, orthopaedic surgery, urology and gynaecology.
Micro-vascular free tissue transfer is that aspect of microsurgery
which involves the use of micro-surgical techniques to move
tissue or tissues from one part of the body to another and
to re-establish blood flow in those tissues using micro
surgical techniques.
To understand micro-vascular free tissue transfer some terms
need defining;
• Flap
- a flap is a block of tissue that may include many or all
of the following; skin, fascia, muscle, bone and joint.
Such a block of tissue may be a recognised structure such
as a toe or may be cut, by the surgeon to include the tissues
he desires. A flap will have a blood inflow, the artery
and a blood outflow, the vein.
• Donor site - the donor site is that
part of the body from where the flap is taken (harvested).
• Recipient site - the recipient site
is that part of the body to which the flap is moved.
• Re-vascularisation - micro-vascular
techniques enable the blood flow in the flap to be re-established
at the recipient site. This re-establishment of blood flow
is known re-vascularisation.
Indications
The indications for micro-vascular free tissue transfer
are ever expanding.
Plastic surgery is about the reconstruction of form and
function due to a large variety of congenital (born with)
defects as well as defects acquired through disease processes.
Many of these defects are amenable to reconstruction using
micro-vascular free tissue transfer techniques.
There is a large number of potential free flap donor sites
and this give the surgeon a large choice of reconstructive
options. Examples of free tissue transfer techniques include;
moving toes to replace missing thumbs; moving skin and fat
from the abdomen to recreate a breast; moving skin from
the forearm to replace the lining of the mouth; moving bone
from the leg to replace the jaw and moving muscle from the
back to cover exposed fracture sites in the leg. These are
a small number of examples of the many indications for micro-vascular
free tissue transfer.
Anaesthetic
Micro-vascular free tissue transfer is invariably carried
out under general anaesthesia.
Length Of Operation
Five to twelve hours.
Time In Hospital
The time in hospital following these procedures is highly
variable. A typical hospital stay may be five to seven days.
Micro-vascular free tissue transfer is a major and complex
surgical undertaking. The patient may spend a short period
of time in intensive care following the operation. The patient
will have many tubes and catheters in the early post operative
period. The patient is typically nursed in a very warm environment
and is regularly monitored for adequate perfusion of the
flap. This whole procedure is extremely demanding both physically
and mentally on the patient.
Time Off Work
Highly variable; depends on many factors.
Risks And Complications
The general complications applicable to all surgical procedures
are associated with micro-vascular free tissue transfer.
Specific complications may be related to the flap donor
site and the flap recipient site. Complications at the flap
donor site include wound breakdown and delayed healing.
Fluid may collect at certain donor sites, this is known
as seroma formation. Injury to structures in the vicinity
of the donor sites may also occur. Free flap surgery may
be thought of as "robbing Peter to pay Paul".
One has to accept some donor site problems that, at least,
there will be a scar.
Problems at the recipient site - the main problem at the
recipient site is flap loss. Flap loss may be due to blockage
of the micro-vascular joins, which may result in complete
loss of the flap.
Outcome
In experienced hands success rates as measured by flap survival,
are about ninety five percent. The success rates of free
flaps performed for acute trauma are slightly less than
those performed for elective reasons such as breast reconstruction.
Overall micro-vascular free tissue transfer has opened a
whole new world of reconstruction to the surgeon and their
patients.
