Tissue transfer utilizing microsurgical techniques is used to cover exposed vital structures such as joint surfaces, tendons, vessels and bone; to restore shape, such as in the breast after mastectomy; and to restore function, like in the muscles of the face. Indications for microsurgical reconstruction and the type of flap used depend on the type of tissue required and the size and location of defect.
Free flaps can be categorized into 2 different types of transplants. Isolated tissue transplants include skin, fascia, muscle, nerve, or bone individually. The more common composite tissue transplant represents a more complex flap and provides more than one type of tissue.
Extensive tissue loss to the lower extremity, due to traumatic injury such as motor vehicle injury, can be repaired using microvascular free flaps. The ability to add healthy and well vascularized tissue to a traumatized limb is critical to achieve early definitive wound healing and restoration of function, salvage of impending amputations, and better esthetic results.
The use of the muscle-sparing free transverse rectus abdominis myocutaneous (TRAM) flap in breast reconstruction allows for excellent shape and contour of the breast mound, while minimizing donor site morbidities. With the incorporation of microsurgery in breast reconstruction, refinements in this flap have produced a free flap with a robust blood supply, less muscle and fascia harvest, and success rates approaching 100%. Other methods of autogenous reconstruction with free tissue transfer are available for patients who are not candidates for free TRAM flap.
Large defects following cancer removal can be repaired using free flaps. Radial forearm and anterolateral thigh flaps are good for reconstruction of facial defects as they are thin and pliable, and allow for contouring over the facial skeleton.