15757 Free skin flap with microvascular anastomosis

Name of the Procedure:

Free skin flap with microvascular anastomosis (also known as free flap surgery or microvascular flap surgery)

Summary

Free skin flap with microvascular anastomosis is a surgical procedure where a piece of tissue, including its blood vessels, is transplanted from one part of the body to another. The blood vessels of the transplanted tissue are carefully reconnected to blood vessels at the recipient site using microvascular techniques to ensure proper blood supply.

Purpose

This procedure addresses defects or damage to the skin and underlying tissues, often due to trauma, cancer, or infection. The goal is to restore form and function to the affected area by providing healthy tissue with an intact blood supply.

Indications

• Large or complex wounds or defects
• Reconstructive surgery after cancer removal (e.g., breast, head, and neck cancers)
• Severe burns
• Areas of poor blood supply requiring vascularized tissue

Preparation

• Patients may need to fast for several hours before surgery.
• Preoperative imaging and blood work are typically required.
• Patients should inform their doctor of any medications they are taking, and some medications may need to be adjusted or discontinued.
• Smoking cessation is recommended to improve healing.

Procedure Description

1. The patient is placed under general anesthesia.
2. The surgeon harvests the donor tissue, including skin, fat, muscle, or bone, along with its supplying blood vessels.
3. The surgeon prepares the recipient site by cleaning the area and identifying the recipient blood vessels.
4. The harvested tissue is transplanted to the recipient site.
5. Microvascular techniques are used to connect the donor blood vessels to the recipient blood vessels using specialized instruments and sutures.
6. The transplanted tissue is secured, and both the donor and recipient sites are closed with sutures or staples.

Duration

The procedure typically takes 4 to 12 hours, depending on the complexity and the specific sites involved.

Setting

This surgery is performed in a hospital operating room.

Personnel

• Plastic or reconstructive surgeon
• Anesthesiologist
• Surgical nurses
• Operating room technicians

Risks and Complications

• Infection
• Bleeding or hematoma
• Blood clot formation
• Partial or complete loss of the flap
• Delayed wound healing
• Scarring
• Anesthesia-related complications

Benefits

• Restoration of form and function to the affected area
• Improved appearance and quality of life
• Functional recovery, such as improved mobility or sensation, depending on the site

Recovery

• Patients will require monitoring in the hospital for several days.
• Pain management will be provided.
• Instructions will include wound care, activity restrictions, and follow-up appointments.
• Full recovery may take several weeks to months, depending on the individual case and complexity.

Alternatives

• Local flap surgery, where tissue is moved from an adjacent area without microvascular anastomosis.
• Skin grafts.
• Non-surgical treatments, such as wound care and physical therapy, depending on the condition.

Patient Experience

Patients will be under anesthesia during the procedure and will not feel pain. Postoperatively, there may be discomfort or pain managed with medications. Patients may experience swelling and bruising, which will diminish over time. Detailed care instructions will be provided to ensure a smooth recovery.