Free Flap

Many reconstructive techniques have been developed in reconstructive plastic surgery to deal with the problems arising following removal of skin growths or after injuries. These techniques are based on the concept of removing flap, i.e. tissue, from one part of the body and transferring it to cover the histological gap. The flap may be just skin; skin and fat; muscle; muscle, fat and skin; fascia; or it may even contain bone. The flap perfusion may be random and thus the flap may to be transferred to a neighboring skin area, or it may be axial, from a specific blood vessel, and can only be transferred with microsurgery techniques (free flap).

Microsurgery requires the use of a microscope so that the surgeon can connect vessels that are 1-2 mm (0.04-0.08 in.) thick. Nowadays, these techniques have become much more detailed and effective with the use of the Da Vinci robotic system. The procedures are time-consuming, and depending on the case and the type of flap, they may last from 2.5 to 6 hours. Patients have to be hospitalized for at least 5 days, requiring 24-hour monitoring for the first four days. Free flaps are necessary to cover skin gaps on the lower tertile of the lower extremities, big gaps on the face and scalp, in breast reconstructions, in bilateral mastectomies, in gaps on the bones, especially the jaw, etc. In all cases, the selection of the flap and the technique to be performed are determined by the surgeon, after assessing the extent and position of the problem.

The main complication of this type of surgeries is failure to restore perfusion to the flap due to anastomatic thrombosis of the vessels.