Name of the Procedure:

Free muscle or myocutaneous flap with microvascular anastomosis

• Common names: Free flap surgery, Free tissue transfer
• Medical terms: Myocutaneous flap, Microvascular reconstruction

Summary

Free muscle or myocutaneous flap with microvascular anastomosis is a surgical procedure where tissue, including muscle and skin, is transferred from one part of the body to another to repair defects or wounds. This tissue transfer is facilitated through the reconnection of blood vessels under a microscope, ensuring the transplanted tissue has a blood supply and can thrive in its new location.

Purpose

The procedure is designed to reconstruct areas of the body that have lost tissue due to trauma, cancer surgery, or other medical conditions.

• Goal: To restore function and appearance to damaged or missing tissue areas.

Indications

• Large or complex wounds that cannot be closed with simpler methods
• Defects following cancer surgery (e.g., head and neck cancers, breast reconstruction)
• Severe traumatic injuries
• Chronic non-healing wounds or ulcers

Patient criteria:

• Overall good health to tolerate surgery
• Adequate blood flow to support tissue transfers

Preparation

• Fasting typically required for at least 8 hours before surgery
• Medication adjustments may be necessary (e.g., blood thinners, diabetic medications)
• Preoperative blood tests and imaging studies to assess overall health and plan the surgery

Procedure Description

1. Anesthesia: General anesthesia is administered.
2. Tissue Harvesting: A suitable donor site on the body is selected, and tissue, including skin, muscle, and accompanying blood vessels, is carefully removed.
3. Recipient Site Preparation: The area needing reconstruction is prepared, including the identification and preparation of recipient blood vessels.
4. Microvascular Anastomosis: The harvested tissue is transferred to the recipient site, and its blood vessels are attached to the recipient's vessels under a microscope.
5. Closure: Both the donor and recipient sites are closed with sutures.

Tools and technology:

• Microsurgical instruments
• Surgical microscope

Duration

The procedure typically takes 4 to 12 hours, depending on the complexity and location of the reconstruction.

Setting

This procedure is performed in a hospital's operating room under sterile conditions.

Personnel

• Surgeons specialized in plastic and reconstructive surgery
• Anesthesiologists
• Operating room nurses and surgical technicians

Risks and Complications

Common risks:

• Infection
• Bleeding
• Blood clots

Rare risks:

• Flap failure due to poor blood supply
• Anesthesia-related complications

Benefits

• Effective restoration of function and appearance of damaged tissues
• Improved quality of life
• Healing of otherwise non-healing wounds

Recovery

• Hospital stay ranging from several days to a week
• Detailed wound care instructions for both donor and recipient sites
• Pain management typically involving oral pain relievers
• Gradual return to normal activities over 4 to 8 weeks
• Follow-up appointments for monitoring flap viability and overall recovery

Alternatives

• Local flaps: Tissue transfer from adjacent areas without microvascular connection
• Skin grafts: Simple transfer of skin layers without muscle or blood vessel reconnection
• Prosthetics: Use of artificial devices to replace tissue function and appearance

Patient Experience

During the procedure, the patient will be under general anesthesia and will not feel anything. Post-procedure, patients may experience discomfort, pain, and swelling at both the donor and recipient sites. Pain is typically managed with prescribed pain relievers. Patients will be encouraged to walk and move gently early during recovery to promote healing, but specific activity restrictions will be outlined by the medical team.