Microsurgery is that surgical speciality that requires magnification for its completion. Microsurgery covers many surgical specialities including plastic surgery, ophthalmology, neurosurgery, ENT surgery, orthopaedic surgery, urology and gynaecology.

Micro-vascular free tissue transfer is that aspect of microsurgery which involves the use of micro-surgical techniques to move tissue or tissues from one part of the body to another and to re-establish blood flow in those tissues using micro surgical techniques.

To understand micro-vascular free tissue transfer some terms need defining;

Flap - a flap is a block of tissue that may include many or all of the following; skin, fascia, muscle, bone and joint. Such a block of tissue may be a recognised structure such as a toe or may be cut, by the surgeon to include the tissues he desires. A flap will have a blood inflow, the artery and a blood outflow, the vein.

Donor site - the donor site is that part of the body from where the flap is taken (harvested).

Recipient site - the recipient site is that part of the body to which the flap is moved.

Re-vascularisation - micro-vascular techniques enable the blood flow in the flap to be re-established at the recipient site. This re-establishment of blood flow is known re-vascularisation.

Indications

The indications for micro-vascular free tissue transfer are ever expanding.
Plastic surgery is about the reconstruction of form and function due to a large variety of congenital (born with) defects as well as defects acquired through disease processes. Many of these defects are amenable to reconstruction using micro-vascular free tissue transfer techniques.

There is a large number of potential free flap donor sites and this give the surgeon a large choice of reconstructive options. Examples of free tissue transfer techniques include; moving toes to replace missing thumbs; moving skin and fat from the abdomen to recreate a breast; moving skin from the forearm to replace the lining of the mouth; moving bone from the leg to replace the jaw and moving muscle from the back to cover exposed fracture sites in the leg. These are a small number of examples of the many indications for micro-vascular free tissue transfer.

Anaesthetic

Micro-vascular free tissue transfer is invariably carried out under general anaesthesia.

Length Of Operation-Five to twelve hours.

Time In Hospital

The time in hospital following these procedures is highly variable. A typical hospital stay may be five to seven days. Micro-vascular free tissue transfer is a major and complex surgical undertaking. The patient may spend a short period of time in intensive care following the operation. The patient will have many tubes and catheters in the early post operative period. The patient is typically nursed in a very warm environment and is regularly monitored for adequate perfusion of the flap. This whole procedure is extremely demanding both physically and mentally on the patient.

Time Off Work

Highly variable; depends on many factors.

Risks And Complications

The general complications applicable to all surgical procedures are associated with micro-vascular free tissue transfer. Specific complications may be related to the flap donor site and the flap recipient site. Complications at the flap donor site include wound breakdown and delayed healing. Fluid may collect at certain donor sites, this is known as seroma formation. Injury to structures in the vicinity of the donor sites may also occur.

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