Dr. Hatcher G. Cox, MD

Flaps are used to reconstruct large or deep wounds, as well repair physical deformities. For example, some nasal defects can be corrected using forehead flaps. Another common procedure that uses flaps is breast reconstruction, which is surgery to restore the appearance of the breast after mastectomy (breast removal). The ability to use musculocutaneous tissue makes flaps ideal for this type of reconstructive surgery. In addition, the included blood supply in flaps brings needed oxygen and nutrients to the recipient site, promoting healing.

During flap surgery, an enormous amount of attention needs to be paid to the blood vessels (arteries, veins, and capillaries). To retain the flap's blood supply, the surgeon might form a pedicle, which is a bridge of tissue and blood vessels that connects the flap to the site it originates from. The flap is connected to its blood supply through this pedicle. It is removed only after the surgical team has made sure that the flap has healed enough to survive without it. This type of flap is called a pedicled flap.

Blood vessels may also be detached from the flap when it is harvested, and then reattached at the new location. Since the flap is not pedicled to its donor site, it is referred to as a free flap. To be able to connect blood vessels with accuracy, surgeons must use very tiny tools and special microscopes. For this reason, this type of flap reconstruction is also often called microvascular flap surgery. One advantage of free or microvascular flaps is that they are ideal for repairing larger areas, like an extensive wound or defect on the leg.

Depending on how involved a patient's flap reconstruction is, they may have to stay in the hospital for several days after the procedure. It may take six to eight weeks for the incisions to heal, and a year or more for the scars to fully fade.

In all cases, the skin graft may either be full-thickness or partial-thickness. While thicker grafts make recovery more difficult for the donor site, they heal more easily than thinner grafts.

Before skin graft surgery, patients are given anesthesia so they cannot feel any pain. If using an autograft, the surgeon carefully measures and removes the skin from the donor site. Sometimes the graft is cut in a mesh-like pattern, to allow a small piece of donated skin to stretch and cover a larger area. This also helps oxygen pass through the graft. The site where the skin graft will go is cleaned well to remove any dirt, bacteria, or dead skin cells. Then the skin graft is placed and attached with stitches or staples. It is often covered with antibacterial ointment and supportive bandages for the first few days.

As the skin graft heals into its new position, new blood vessels grow to reach and support the skin. Depending on the thickness of the graft, oil glands, sweat glands, and hair follicles may also regrow. Recovery time depends on the thickness of the graft and the overall health of the skin in the grafted area, but it generally takes from two to four weeks.

During trigger finger surgery, the tendons at the base of the affected finger are identified and the sheath is opened up, allowing the tendons to move freely without getting stuck. This can be done through a tiny incision in the palm, or even without an incision at all, using the tip of a needle. Most people are able to move their fingers normally, bending and straightening their finger without catching or popping, right away after surgery. Although patients may have some pain and stiffness as they heal, recovery is quick.