What is Flap Reconstruction?

Flap reconstruction is a surgical procedure in which healthy tissue is taken (or harvested) from one area of the body, called a donor site, and then transferred to a damaged area, or recipient site. The most common types of tissue used in flap reconstruction are skin, muscle, and a combination of skin and muscle, called musculocutaneous tissue. Flaps are like grafts in that they both involve harvesting and transferring tissue, but they differ in one important way. Flaps are placed onto the recipient site with their own blood supply, whereas grafts are not.

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 your flap reconstruction is, you 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.

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