There are circumstances when a large area of tissue on the face is damaged or surgically removed. Some possible causes are cancer removal, immune and inflammatory diseases, radiation, and trauma. Reconstruction of these defects is challenging and requires a free tissue flap.
A free flap is when a section of tissue, along with its blood supply, is completely detached from a healthy area of the body (the donor site) and reattached where the tissue is missing (the recipient site). This type of tissue transfer requires reconstituting the blood supply by using microsurgery to reconnect the arteries and veins.
Free flap surgery requires a reconstructive surgeon as well as a microvascular surgeon. They work together to separate the flap from the donor area while dissecting its vein and artery. The vein and artery in the recipient area are prepared and the free flap is transferred into the defect.
The veins and arteries are then carefully reconnected using a microscope. The flap is shaped and sutured in place. The new micro-vascular anastamosis is monitored to ensure vessels are patent and have good blood flow. The donor site is closed, often using a skin graft. Following surgery, a hospital stay is required so that the circulation of the flap can be closely monitored.
This type of surgery is very complex and lengthy. Donor site is chosen based on the recipient site tissue characteristics. Facial defects are frequently reconstructed with forearm free flaps. This ability to transplant living tissue from one region of the body to another has greatly facilitated the reconstruction of complex facial defects.
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