Name of the Procedure:

Free Osteocutaneous Flap with Microvascular Anastomosis; Excluding Iliac Crest, Metatarsal, or Great Toe

Summary

A free osteocutaneous flap with microvascular anastomosis is a complex surgical procedure where bone and skin tissue from one part of the body are transplanted to another site. This procedure helps repair significant bone and soft tissue defects. The term "free" indicates that the tissue is completely detached from its original location before being reattached at the new site using microsurgery to connect tiny blood vessels.

Purpose

This procedure is performed to address the following:

• Significant bone and soft tissue loss due to trauma, infection, or tumor removal.
• Reconstruction of complex skeletal defects.

The goal is to restore both the form and function of the affected area, ensuring proper blood supply and healing.

Indications

• Large bone defects that cannot heal on their own or with simpler procedures.
• Complex tissue injuries requiring vascularized bone and soft tissue transfer.
• Chronic infections or cancerous lesions requiring removal of affected bone and tissue.

Preparation

• Preoperative fasting for at least 6-8 hours.
• Adjustments or cessation of certain medications (e.g., blood thinners).
• Preoperative imaging studies such as CT scans or MRIs to plan the procedure.

Procedure Description

1. The patient is placed under general anesthesia.
2. An incision is made to harvest the osteocutaneous flap including both bone and skin tissue from a donor site other than the iliac crest, metatarsal, or great toe.
3. The flap is completely detached and microsurgery is used to connect its blood vessels to those near the recipient site.
4. The new tissue is positioned and secured, ensuring proper alignment and blood flow.
5. Incisions are closed, and the surgical site is carefully monitored.

Duration

The procedure typically takes 6-12 hours, depending on the complexity of the defect and the location of the flap.

Setting

The procedure is performed in a hospital operating room equipped with specialized microsurgical tools.

Personnel

• Lead Surgeon (often specialized in plastic or orthopedic surgery)
• Anesthesiologist
• Nursing staff
• Surgical technologists
• Microsurgical specialists

Risks and Complications

Common Risks:

• Infection
• Blood clots
• Scarring

Rare Complications:

• Flap failure due to inadequate blood supply
• Nerve damage
• Chronic pain at donor or recipient site
• Need for additional surgeries

Benefits

• Restoration of structural integrity and function of the affected area.
• Improved aesthetic appearance.
• Enhanced healing due to restored blood supply.

Recovery

• Hospital stay of 5-7 days for initial recovery.
• Follow-up appointments for monitoring healing and flap viability.
• Restrictions on physical activity for several weeks to months.
• Physical therapy may be required to regain full function.

Alternatives

• Bone grafting using less complex techniques.
• Use of synthetic bone substitutes.
• Limb-sparing surgeries without tissue transfer.

Pros and Cons of Alternatives:

• Less invasive procedures might have shorter recovery but may not be suitable for complex defects.
• Synthetic substitutes avoid donor site morbidity but may not integrate as well as natural tissue.

Patient Experience

During the Procedure:

• The patient will be under general anesthesia and will not feel pain during surgery.

After the Procedure:

• Postoperative pain managed with medication.
• Initial discomfort and swelling at both donor and recipient sites.
• Gradual improvement in mobility and function as healing progresses.
• Regular pain management and physical therapy to aid recovery.

Pain Management and Comfort Measures:

• Pain medications as prescribed.
• Supportive care including ice packs and compression garments.