Free fascial flap with microvascular anastomosis
CPT4 code
Name of the Procedure:
Free Fascial Flap with Microvascular Anastomosis
Summary
A free fascial flap with microvascular anastomosis is a surgical procedure in which a piece of tissue (fascial flap) with its own blood supply is entirely detached from its original location and transferred to a new site. The blood vessels of the flap are then connected to blood vessels at the new site using microsurgical techniques.
Purpose
The procedure is used to repair and reconstruct areas with significant tissue loss or damage. The goals are to restore both function and appearance, often after trauma, cancer surgery, or infections.
Indications
- Severe tissue damage or loss
- Reconstructive surgery after tumor removal
- Chronic wounds or ulcers not healing with standard treatments
- Specific patient criteria include sufficient health to undergo surgery and adequate donor tissue.
Preparation
- Patients may need to fast for a specified period before the surgery.
- Medications may need to be adjusted as per the surgeon's instructions.
- Preoperative assessments include blood tests, imaging studies, and possibly a cardiovascular evaluation.
Procedure Description
- Anesthesia: General anesthesia is administered to keep the patient asleep and pain-free during the procedure.
- Tissue Removal: The surgeon identifies and harvests a flap of tissue, including layers of fascia and associated blood vessels, from the donor site.
- Flap Transfer: The flap is entirely detached with its blood vessels.
- Microvascular Anastomosis: Using a high-powered microscope, the surgeon connects the flap's blood vessels to recipient site vessels, restoring blood flow.
- Wound Closure: The donor and recipient sites are closed with sutures.
Tools and equipment include microsurgical instruments and a surgical microscope.
Duration
The procedure typically takes between 4 to 8 hours, depending on the complexity.
Setting
Performed in a hospital operating room.
Personnel
- Lead Surgeon (specialized in plastic or reconstructive surgery)
- Surgical assistants and nurses
- Anesthesiologist
- Microvascular surgical team
Risks and Complications
- Infection
- Bleeding
- Flap failure due to inadequate blood supply
- Blood clots
- Scarring
- Anesthesia-related complications
Benefits
- Effective tissue repair and aesthetic improvement.
- Restoration of function to damaged areas.
- Benefits may be realized within weeks to months, following initial recovery.
Recovery
- Hospital stay for several days post-surgery.
- Pain management with prescribed medication.
- Instructions to avoid strenuous activities.
- Follow-up appointments for monitoring blood supply to the flap and overall healing.
- Complete recovery could take several weeks to months.
Alternatives
- Skin grafts
- Local flap procedures (tissue moved from adjacent areas)
- Negative pressure wound therapy
Each alternative comes with its own benefits and limitations depending on the specific case details.
Patient Experience
- During the procedure: The patient is under general anesthesia and will not feel any pain.
- Post-procedure: Expect soreness, swelling, and mild discomfort at the surgical sites. Pain will be managed with medication.
- Full healing may involve physical therapy and rehabilitation in some cases.