Expertise
Free Flap Surgery
The free flap surgery or the autologous tissue transfer and microvascular free tissue transfer is synonymous term are used to describe the tissue transplantation from one area of the body to another, in order to reconstruct an existing defect.
The free flap surgery is usually performed by the disconnection of the tissue, which is also termed free flap from its original blood supply and further moved a significant distance to be reconnected to a new blood supply.
The free flap surgery is done by the initiation of the harvesting process in which a flap of healthy tissue is harvested from the areas where it is not as important, i.e., remote sites in the body with the blood supply and further transferred to the areas where the wound is affected. However, the wound area is recipient site and the remote areas from where the tissue with blood vessels has been harvested are known as the donor area. Thus, the tissue transfer in the free flap surgery is also a two-way process in which donor, as well as recipient areas, is required to fulfil the need for free flap surgery.
FREE FLAP
What is Free Flap?
Transfer of tissues from one place to another with anastomosis of the flap vascular pedicle to the recipient vessels to provide blood supply to the flap.
Free flap is the topmost modality in the management of reconstructive surgery if other options of local, regional flaps are not possible.
Free flap option can be used to salvage a limb and for the conditions that need to undergo multiple secondary reconstructive procedure.
Case History
This 3 year old boy presented with composite tissue loss over the medial aspect of right ankle and hind foot following run over by tractor ,exposing the medial malleoli and calcaneum with segmental loss of Tibial nerve and Posterior tibial vessels.
He underwent initial wound debridement and skeletal stabilization.
He underwent Anterolateral thigh flap (ALT) cover using posterior tibial vessels.
He needs tibial nerve reconstruction later to restore sensation to the plantar aspect of foot.
Flap
What is Flap?
Open fracture of the lower limb with soft tissue loss can lead to infection, non-union, which will delay the ambulatory status of the individual.
All open fractures need thorough debridement with loupe magnification, skeletal stabilization, and early soft tissue cover.
Fasciocutaneous flaps like Reverse sural artery based flap, anterior tibial artery perforator based propeller flap.
Muscle flaps like gastrocnemius flap, soleus flap for open fracture will help in bone healing and in subsequent secondary procedures like bone grafting and bone lengthening procedures.