Flap Surgery & Microsurgery

Flap surgery is reconstructive surgery at its most sophisticated. A flap is a unit of living tissue -- skin, fat, muscle, or bone -- transferred from one part of the body to another, carrying its own blood supply. This makes it the method of choice for closing complex defects where simpler techniques are insufficient.

Microsurgery is the subspecialty where blood vessels smaller than 1mm in diameter are joined under an operating microscope -- allowing tissue to be transplanted anywhere in the body with its blood supply reconnected at the recipient site. Dr. Bhavya Sree has Fellowship training in microsurgery and flap reconstruction, bringing this advanced capability to patients in Visakhapatnam.

Microsurgery and free flap reconstruction represent the pinnacle of plastic surgery -- giving patients with complex defects the opportunity for reconstruction that was simply not possible a generation ago. Dr. Bhavya Sree's Fellowship-level microsurgical training makes this available to patients in Visakhapatnam without the need to travel to a major metropolitan centre.

Types of Flaps Description

Flap Type Tissue advanced, rotated, or transposed from immediately adjacent Local Flaps to the defect. Used for smaller facial and body defects. Regional Flaps Tissue transferred from a nearby anatomical region on a defined Free Flaps (Microsurgical) pedicle (blood vessel). E.g. latissimus dorsi (LD) flap, pedicled TRAM flap. Perforator Flaps Tissue completely detached from its donor site and re-anastomosed to vessels at the recipient site under the operating microscope. The gold standard for complex reconstruction.

Only skin and fat are taken, based on perforating vessels, sparing underlying muscle. E.g. DIEP, SGAP, ALT flaps. Reduces donor site morbidity significantly. Common Applications Application Flap Type Used Breast Reconstruction DIEP flap, TRAM flap, LD flap -- using abdominal or back tissue to rebuild the breast after mastectomy Head & Neck Following oral cancer, tongue, jaw, or throat resection -- free flaps Reconstruction rebuild speech and swallowing function Lower Limb Reconstruction Covering exposed bone, tendon, or implants in the leg following trauma, infection, or tumour excision Scalp & Skull Following traumatic avulsion, tumour excision, or radionecrosis Reconstruction Post-Burn Reconstruction Release of contractures and resurfacing of functional areas with well-vascularised flap tissue Pressure Sore Rotation or advancement flaps close deep pressure sores -- Reconstruction durable coverage where skin grafts repeatedly fail

Anaesthesia General anaesthesia

Duration 4-8 hours (free flap); 1.5-3 hours (local/regional flap)

Hospital Stay 5-10 days (free flap); 2-3 days (regional flap)

Flap Monitoring Hourly for first 48-72 hours post-op -- critical Free Flap Success Rate >95-98% in experienced hands Final Result 6-18 months

Frequently Asked Questions

What makes a free flap better than a skin graft for complex wounds?

A skin graft relies entirely on the wound bed for its blood supply -- it will not survive on poorly vascularised surfaces (exposed bone, tendon, metal implants, or irradiated tissue). A free flap brings its own blood supply, making it capable of surviving on any recipient site, regardless of local tissue quality. What happens if a free flap fails? Despite best efforts, free flaps occasionally fail due to vessel thrombosis -- typically within the first 24-48 hours. Early return to theatre for re-anastomosis can salvage the flap if recognised promptly -- hence the intensive post-operative monitoring. Overall failure rates in experienced units are under 2-5%. Complex defects need the highest level of reconstructive expertise -- drbhavyaplasticsurgery.com