A free flap is a surgical procedure where donor tissue is taken from one location on the body, like the leg, and transferred to another. Free flaps are commonly used during reconstructive surgery, and they require advanced surgical skills, including training in microsurgery. If a patient is a good candidate for this procedure, a surgeon will discuss the options during a surgical consultation and provide the patient with information about the specific risks and benefits of a given procedure.
In any kind of flap tissue transfer, the donor tissue includes underlying blood vessels, as well as skin and fat. This increases the chance of a successful graft, as the flap can be supplied with blood immediately. This promotes rapid healing, will help the tissue heal more naturally, and decreases the risk of transplant rejection. Using a flap from the patient's own body also minimizes rejection risk and prevents a patient from being exposed to potential risks, like infectious materials in donor tissue. Although tissue is rigorously screened before being released for use in surgery, rarely microorganisms can slip through.
In a free flap procedure, the surgeon will mark out the area being used as a donor site, and prepare the recipient site. The donor tissue is carefully cut to generate a piece of the needed size and shape. Until the last possible moment, the tissue remains attached to the body by the vascular pedicle, a fancy way of saying that several blood vessels are left in place to keep the graft supplied with blood. Once the recipient site is ready, the vascular pedicle is severed, the free flap is moved to the new site, and blood vessels on the graft are sutured to vessels at the site, using microsurgery.
The length of this procedure can vary, depending on the amount of reconstruction needed, the size of the flap, and the placement. The surgeon exercises care to limit the risk of scarring and is also concerned about infection and possible complications. The patient will remain under general anesthesia throughout the procedure to minimize pain and discomfort. Once the free flap is in place and the surgeon is satisfied, the patient can be brought into recovery.
After a free flap surgery, the site will need to be inspected regularly. Nurses and doctors will change bandages, clean the site, and check for signs of infection, rejection, and other complications. The patient will need to keep the area clean and dry in the early stages of healing. If the graft takes successfully, it can take several years for the scars at the surgical site to fade, and some scarring will always be visible.