Free Flap (Free Tissue Transfer)

Last updated 18.03.13

 

Index

 

Definition

-  Surgical transfer of tissue including blood supply from one site to anther

 

Features

-  Donor site provides tissue to recipient site

-  Requires microsurgical connection of vessels (artery & vein) for viability

-  Differs from pedicled flap where still attached to donor site

 

Indications

-  Breast reconstruction

-  Traumatic reconstruction

-  Some head & neck surgery

 

Types

-  TRAM (Transverse Rectus Abdominis Myocutaneous) Free Flap

-  Radial Forearm Flap

-  Rotation Flap

 

Procedure

-  Flap donor site marked

-  Dissection from surrounding tissue

-  Vascular pedicle identified (vein & artery)

-  Preparation of recipient site

-  Recipient vein & artery identified

-  Dissection of vascular pedicle & transfer to donor site

-  Anastamosis of vascular pedicle w microsurgery

-  Closure of flap ensuring blood flow

-  Often hand held US is used to mark skin site above vascular pedicle to fascilitate ongoing Doppler review

-  Donor repair: closure or SSG

 

Post Op Mx

-  Regular observations of free flap

-  Every 15min 1st 8hrs+/- then 1/2hrly+

-  Capillary refill

-  Doppler ultrasound

-  Color & temperature

-  Tissue resistance

-  IV hydration initially: Hartmans only

-  Maintain urine output 30-50mls+/hr

-  Avoid HTN w careful regulation