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Microvascular Surgery – Advantages And Disadvantages Of Free Tissue Transfer

Surgery on very small blood vessels such as those only 1 to 3 millimeters in diameter. Microvascular surgery is done through an operating-room microscope using specialized instruments and tiny needles with ultrafine sutures. Microvascular surgery is used to reattach severed fingers, hands, arms, and another amputated parts to the body by reconnecting the small blood vessels and restoring the circulation before the tissue starts to die. Microvascular surgery also can be used in reconstructive surgery.

Microvascular Surgery Means Doing Ananstomosis Of blood Vessels Under Microscope.

Free Flaps surgery is the transfer of skin, muscle or bone that is totally freed from the body with the artery and vein to a site needing reconstruction. Blood supply is re-established immediately by suturing the artery and vein to a nearby blood supply.

Microvascular Surgery techniques

Microvascular Surgery is performed through the use of a microscope, specialized instruments and tiny needles with ultra fine sutures. Using these techniques, three to five millimeter vessels can be repaired, enabling the reattachment of amputated fingers, hands and arms resulting from accidents or other trauma. This is called replantation surgery. Free-tissue transfer or free-bone transfer are types of reconstructive microvascular surgical techniques. Free-tissue transfer involves removing muscle with its blood vessels and then transferring the muscle to another location in the body. The muscle’s artery and vein are then hooked up to local blood vessels, which re-establish the muscle’s blood supply. This is often done for soft-tissue defects created by trauma or tumor surgery.

Free-bone transfer in Microvascular Surgery

Free-bone transfer is the removal of a bone with its blood supply. The bone is then implanted into a large bone defect in another area of the body.Blood supply is re-established by hooking up the bone’s artery to local arteries and veins. This procedure is particularly helpful for correcting bone defects created by trauma, tumor surgery or for reconstructing non-healing bones.

Advantages And Disadvantages Of Free Tissue Transfer

Advantages

Free flap reconstruction has several advantages over other methods, particularly in the head and neck. Free tissue transfers are usually designed as a single-stage procedure, as opposed to many of the pedicled reconstructions. Pedicled flaps require a less efficient use of tissue as entire muscles are defunctionalized in order to safely transfer enough tissue to fill the defect. Free transfers allow the harvest of exactly tailored grafts, minimizing donor morbidity. Similarly, free tissue transfers are usually associated with less postoperative atrophy, eliminating the need to overcorrect.

Head and neck defects are often inhospitable, requiring contact with saliva, nasal secretions, and tissues previously exposed to radiation and surgery. Well perfused free flaps are suited to these conditions. Pedicled flaps frequently have less perfusion at the margins, which may be very distant from the blood supply. Skull base defects may require a water-tight closure to prevent CSF leakage. Again, excellent perfusion at the wound edges make the free tissue transfers more likely to live up to these expectations.

Bony reconstruction is now virtually synonymous with free tissue transfer. Resorption, which plagued non-viable bony transfers is eliminated. Unlike other reconstructive techniques, primary osseointigration is now possible. Transferring well perfused tissues incites a strong union with the surrounding bone in as little as 1 to 2 months, eliminating the long term use of reconstruction plates.

Both functional and aesthetic advantages are abundant with free tissue transfers. Flap transfers capable of sensation are plausible with the use of neurofasciocutaneous free tissue transfers, unlike any of the pedicled flap transfers. Pedicle flaps are often less than perfect when the defect requires the extremes of massive bulk or thin, pliable tissue. Free flaps are not limited by these constraints. Along the same lines, pedicled flaps often transfer skin of a poor match to the host site. Free transfers provide a much wider range of skin characteristics.

Disadvantages

The principal disadvantage in free tissue transfer is the technical demands required by the technique. A great deal of additional expertise and equipment is required intraoperatively, as well as perioperatively. This drives the costs of the patient’s care up significantly. Although the technique is usually performed with a two-team approach, an average of 4 hours are added to an already lengthy surgical procedure. Even in the most experienced hands, one can expect a 5 to 10 percent flap failure rate, usually due to thrombosis. Flap failure necessitates a second operative procedure as well as additional donor site morbidity if a second flap is required. This problem is encountered less frequently with pedicled flap reconstructions.

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