Microsurgical reconstruction

How microsurgery is used

A free flap transfers living tissue from one area of the body to another. Its blood vessels are disconnected and joined to vessels at the recipient site using microsurgical techniques. Depending on the problem, transferred tissue may include skin, fat, fascia, muscle or bone.

This differs from a local flap, which retains its existing blood supply, and a skin graft, which must develop a blood supply from the wound beneath it. Microsurgical nerve repair or reconstruction may also be considered in selected injuries.

Consultation and planning

Planning considers the defect, circulation, nerve and tendon function, available donor tissue, previous operations, medicines, nicotine exposure and general health. Imaging or assessment by other specialists may be required.

Dr Yue will discuss whether microsurgery is relevant to your concern and the appropriate treating team and hospital arrangements. The specific technique cannot be chosen from a general website description. Complex reconstruction may require coordinated care across surgical specialties, cancer teams or rehabilitation services.

Alternatives may include direct closure, grafts, local or regional flaps, staged treatment or non-operative care, depending on the problem.

Hospital care and recovery

Free-flap reconstruction usually involves general anaesthesia and inpatient monitoring. Staff check the tissue circulation closely after surgery. A problem with blood flow may require urgent return to theatre, and successful tissue survival cannot be guaranteed.

Recovery involves both the reconstructed area and the donor site. Dressings, drains, movement restrictions and rehabilitation depend on the tissues involved. Return to work, driving and exercise varies considerably. A hand therapist, physiotherapist or other rehabilitation professional may be involved.

Scars, risks and limitations

There are scars at the reconstruction and donor sites. Potential risks include bleeding, infection, wound problems, blood-vessel blockage, partial or complete flap loss, altered sensation, weakness or other donor-site problems, blood clots and anaesthetic complications.

Further procedures may be needed to address healing, contour or function. Nerve recovery can be slow and incomplete. Reconstruction aims to improve coverage or function within the limits of the injury or condition; it cannot reliably restore completely normal tissue.

Follow-up and urgent concerns

Follow-up assesses healing, function and rehabilitation. After discharge, follow the specific instructions about protecting the reconstruction and recognising changes in colour, temperature, swelling, pain or wound appearance. Report concerning changes immediately to the treating team.

Chest pain, breathlessness or collapse requires emergency assessment; call 000 in an emergency. For a new severe injury, attend an emergency department rather than waiting for a routine consultation.

Frequently asked questions

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