Free flap

A free flap is a surgical technique used in reconstructive surgery to transfer a composite tissue graft (containing skin, muscle, bone, and/or other tissues) from one part of the body (the donor site) to another (the recipient site). This transfer involves completely disconnecting the tissue from its original blood supply and re-establishing blood flow at the recipient site by microsurgically connecting the arteries and veins of the flap to corresponding vessels in the recipient area.

The key distinguishing characteristic of a free flap is the complete severing and subsequent microsurgical re-anastomosis (reconnection) of the blood vessels. This is in contrast to pedicled flaps, where the tissue remains attached to its original blood supply via a "pedicle" that is rotated or advanced to the recipient site.

Free flaps offer significant advantages over other reconstructive techniques in many situations. They allow for the transfer of larger and more complex tissue volumes, including multiple tissue types within a single flap. This is particularly important in cases where significant tissue loss has occurred due to trauma, cancer resection, or other conditions. The ability to select donor sites based on tissue type and volume allows surgeons to more closely match the reconstructive needs of the recipient site, often resulting in improved functional and aesthetic outcomes. Common donor sites include the abdomen, thigh, and back.

Successful free flap reconstruction relies on meticulous surgical technique, including precise microsurgical anastomosis of blood vessels and careful post-operative monitoring to ensure flap viability. Potential complications include flap failure due to thrombosis (blood clot formation) in the anastomosed vessels, infection, hematoma, and donor site morbidity.