If you’ve had an accident that’s caused extreme tissue damage — the kind that store-bought products can’t fix — then microvascular flap surgery might be your best option.
To understand more about microvascular flap surgery, we spoke with Tolga Turker, MD, an orthopedic surgeon at Banner - University Medicine Multispecialty Services Clinic in Tucson, AZ. Dr. Turker explained what you can expect from this surgery, the most common versions of the surgery and the best ways that you can help the surgery succeed.
What is microvascular flap surgery?
Microvascular flap surgery rebuilds damaged tissue by transplanting healthy tissue from another part of your body. During flap surgery, small blood vessels at the donor and recipient tissue are sewn together. This isn’t the same as a skin graft, since a “flap” is tissue, which includes more than just skin. Dr. Turker said patients often mistakenly think it will be a simple skin graft. Flap surgery is more complicated.
When Dr. Turker sees a patient for surgery, the cause is usually a vehicle accident — typically from a motorcycle, car or off-road vehicle. In these instances, patients have either tried store-bought solutions that didn’t fix the damaged tissue, or the injury is so extreme that surgery is needed. In Dr. Turker’s experience, the most common injuries here involve the extremities: hands, feet, ankles, shins and forearms.
Two types of flap surgery
Flap surgeries fall into two categories: free flap and rotational/pedicled flap.
In free flap surgery, a piece of healthy tissue is completely removed from your body, then reattached elsewhere. This is the most advanced form of flap surgery, and is considered “microsurgery” since it requires a microscope. Dr. Turker said free flap surgery usually takes between four and eight hours to complete.
Rotational flap surgery, by contrast, keeps a portion of the tissue connected to its original blood source, and the healthy tissue is then rotated to cover the damaged area. This requires expertise, but not microsurgery. Dr. Turker said this method is preferable, because it’s easier, takes less time and has less complications.
Tips for successful flap surgery
As with other surgeries, existing health conditions can slow your recovery, such as diabetes, connective tissue disorders, vascular conditions, old age and chronic disease. Smoking and alcohol can also impede recovery. However, Dr. Turker said his clinic doesn’t want to rule anyone out — after all, flap surgery is usually a patient’s final option when other efforts have failed.
Following a free flap surgery, patients usually stay in the hospital for five days to help limit how much the patient moves around, which can cause the surgical area to swell. During this bed rest, patients are fed high-calorie and high-protein diets, and caffeine intake is limited. This helps the body repair itself. If a patient smokes cigarettes, Dr. Turker encourages them to cut back — quitting is obviously ideal, but he recognizes that may not be realistic.
By contrast, rotational flap surgery has an easier post-op. In some cases, patients can go home the same day of their surgery. If they do stay in the hospital, it’s usually just for a day or two.
With both of these surgeries, Dr. Turker said it’s important for you to take it easy for a while. Getting lots of rest, and not doing any strenuous physical activity for the first few weeks after surgery, is crucial in recovery. You should also take aspirin for at least 10 days after being discharged from the hospital. Your doctor may also recommend other pain relievers and antibiotics during this post-op period.
To learn more about flap surgery and if the procedure may be right for you, visit bannerhealth.com to schedule a visit with a specialist in your area.
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