A free flap is a block of living tissue taken from one part of the body and moved to another, with its artery and vein cut and then stitched to vessels at the new site under a microscope. Once blood flows, the tissue lives where it has been placed. This makes it possible to cover wounds that nothing nearby could reach.
Free tissue transfer sits at the top of the reconstructive ladder, and it is not the automatic answer. Where a graft or a local flap will heal reliably, that simpler route means a shorter operation, fewer nights in hospital and only one wound. Microsurgery earns its place when a defect is deep, when bone is missing, when vessels or implants need blanketing, or when the surrounding skin has been damaged by radiotherapy. Deciding between the two routes is the most important part of the planning discussion.
Flaps are grouped by the tissue they carry. The least complex flap that meets the need at the recipient site is usually the one chosen.
The flap is checked repeatedly around the clock at first, because a blocked vessel found early can often be reopened. Colour, warmth and refill are recorded. That intensive watching is the reason a hospital stay after microsurgery is longer than after simpler cover.
Taking tissue leaves a wound elsewhere. Thigh and forearm donors usually close directly or with a graft, and most people regain full use. Weakness, a visible scar and altered feeling can persist. Donor choice balances what the wound needs against what the donor loses.
Plenty of wounds close well with a graft or a local flap, at far less cost in time and risk. Microsurgery is proposed when nothing simpler will hold up, not because it is technically more impressive than the alternatives.
A small number of flaps fail despite everything. An early return to theatre sometimes rescues them. Where a flap is lost, the wound is dressed and a second plan is made, which may use different tissue or a simpler method of cover.
Once you are home after free flap surgery, the following need urgent assessment.
These answers deal with cost, risk, recovery and how the tissue looks over time.
Ask your question →A long operation, specialised equipment, a closely monitored bed and an extended stay all add up, so this is among the more expensive reconstructive options. Insurance and government schemes cover many cancer and trauma cases. An itemised estimate is given before admission.
Most flaps survive and heal well in experienced hands. The main risks are clotting in the joined vessels, bleeding, infection and problems at the donor site. Smoking, diabetes and vascular disease raise those risks, so each is addressed before surgery where possible.
Expect roughly a week or more in hospital, with limited movement at first while the vessels settle. Wounds heal over several weeks, and swelling in the flap softens across many months. Return to work depends on the site and on the job you do.
Not exactly. Transferred skin keeps the colour, texture and sometimes the hair of the place it came from, so a difference is usually visible. Thinning, laser treatment and scar revision can improve the blend once everything has healed fully.
Suitability depends on the state of your blood vessels, your general fitness for a long anaesthetic, and whether a healthy vessel is available near the wound. Scans of the vessels are sometimes needed. Where the answer is no, other cover is planned instead.
Sometimes. An open fracture or an exposed plate is covered sooner rather than later, because delay allows infection to set in. Reconstruction after cancer follows the timing of the cancer treatment. Elective cases can be scheduled around work and family.
The wound is examined and photographed, pulses in possible donor limbs are checked, and scans are reviewed. You will hear which flap is proposed, where the scar will lie, how long the stay is likely to be, and what could go wrong.
