Plastic Surgery

In the realm of plastic surgery, flaps are large masses of tissue that may include fat and muscle. Flaps are taken from one place on the body and then attached to another area. These operations are much more complex than skin grafts because they involve the need to reestablish various vascular, or blood, connections.

A pedicle flap graft involves connecting the tissue and/or muscle to the new site while keeping part of it attached to the original site. This technique maintains the old blood vessel connections until the flap naturally creates new connections (revascularization) at the transplanted site. For example, a mass of tissue on an undamaged finger can be partially peeled back and connected to an adjacent finger until revascularization takes place. Then the flap can be totally severed from its original site.

A free flap is when tissue or muscles are completely severed from the body and then transplanted to the new site where the blood vessels are then reconnected surgically. An advantage of the free flap procedure is that the transplanted tissue can be taken from anywhere on the body and does not have to be in an area close to (or can be placed close to) the new site.

The advancement of microsurgical techniques have greatly improved the success of free flap surgical procedures. Using a microscope, tiny needles, and nearly invisible thread, the surgeon can painstakingly reconstruct the vascular web that supplies nourishment in the form of blood to the transplanted tissues.