What is facial reconstruction "free flap" surgery?

Vishad Nabili, MD
Ear, Nose & Throat (Otolaryngology)
Free-flap reconstructive surgery depends on what type of defect is located in the head and neck. If it involves part of the jawbone, for example, doctors need to take some tissue that involves bone. They may use part of a leg bone, for example, as the transplanted tissue brought into the head and neck. The doctor will remove the part of the bone and the blood vessels with it and then, under a microscope, sew those tiny blood vessels with sutures that are smaller than human hair. Once revascularized, the flap of tissue is viable but now in a new location.
Stuart A. Linder, MD
Plastic Surgery
Facial reconstruction with free flap surgery includes the use of transfering composite tissue with the neurovascular supply intact. The microvascular replantation includes bone, muscle, nerves, and blood supply (artery and venous supply). Examples include: serratus anterior muscle, gracilus myocutaneous flap, rectus flap, radial forearm free flap, etc. These composite flaps are brought to the recipient area of the facial defect to reconstruct the jaw (mandible), the orbit, the cranium and the midface after cancer extenteration or traumatic loss of tissue. Board certified plastic surgeons with special training in microvascular replantation perform the harvesting and anastamosis under the microscope to maintain ample blood supply for flap survival. 
Free flap surgery to the face may address defects of both form and function. "Free flap" implies that tissue is being harvest from a remote site on the body in a manner in which the blood vessels keeping that tissue alive are still attached to it. These blood vessels are then cut. Because the tissue will not survive without blood supply, the flap vessels are sewn into recipient vessels (arteries and veins already present in the neck or face region) to re-establish flow in and out of the flap.

A free flap may be used to help reconstruct a structure (such as the nose or the cheek). It may also be a functional flap (such as a gracilis or serratus muscle) in cases of facial paralysis. In these cases, a nerve to the muscle must also be left attached then connected to the motor nerve (facial nerve) of the face.

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