When flaps and skin grafts are not appropriate for closure the surgeon then consider the option of vascularized free flaps--also known as microvascular free flaps. This is a hospital based procedure which can require up to a three day overnight stay. The technique involves transplanting soft tissue from different parts of the body with it’s artery and vein to the area that needs to be reconstructed. These are then attached to artery and vein closest to the defect. This vascularized blood supply allows the surgeon to transplant a large amount of tissue and ensure its survival with transplantation.
The most common vascularized free flap is a forearm free flap. It requires reconstruction of the forearm donor site with a split thickness skin graft usually taken from the thigh. The forearm skin is then transplanted to the area of the surgical defect where it is connected to the local artery and vein for blood supply.
Other free flaps can be taken from the upper lateral thigh, yet other free flaps can also transplant soft tissue and bone for reconstruction of much more complex defects. The time period between harvesting a free flap to reattaching to a blood supply in the recipient defect is usually 1-2 hours.