Department of hand surgery & Microsurgery.

Microvascular Free Flaps

What is a free flap?

Free flap surgery involves the transfer of a patient’s own tissue from a donor site to a recipient site, which is typically the site of a defect. The donor site usually has a distant location with respect to the recipient site. Therefore in order to physically transfer tissue while maintaining its viability that tissue’s vascular supply must be divided at the donor site and then reconnected through the creation of anastomosis at the recipient site.


Microsurgery is a specialised form of surgery performed with the aid of an operation microscope and involves the use of a range of advanced techniques designed for working on very fine structures such as nerves and blood vessels. In free flaps a donor area with abundant suitable tissue is selected, from which tissue is removed and transferred to the reconstruction site. Blood vessels are then re-connected, establishing blood flow and allowing the tissue to fully integrate within the new location. These sophisticated techniques enable the reconstruction of almost any tissue in the body.

Who performs such complex procedures ?

An orthopaedic or plastic surgeon who has undergone specialised training in microsurgery is able to perform such procedures.

What are the indications for using a free flap?

Trauma, post tumour resection, congenital defects or chronic wounds where a free flap would give the optimum functional result or aesthetic.

  • Large defects
  • Defects requiring multiple tissue types
  • Areas that need freshly vascularised tissue.
  • No local options for flap
What type of anaesthesia is used for the procedure ?

It depends on the age of the patient, associated diseases ,and complexity of the wound. Two types of anaesthesia are commonly used . Regional anaesthesia : Your anaesthesia doctor will make your upper or lower limb numb by giving an injection near your collarbone ( for upper limb ) or on your back ( for lower limb ). You will feel no pain but you will be awake. General anaesthesia : Your anaesthesia doctor will make you sleep .

What is the duration of surgery ?

Duration depends on the complexity of the wound. It usually takes 3-6 hours of surgical time.

When is the most critical for a patient with a free flap?

Free flap vascular problems typically occur during the first 72 hours post op. Free flaps are generally monitored starting immediately postoperatively until at least day 3 and in some cases for additional days depending on the nature of the procedure (e.g. difficulty) and surgeon preference.