MICROVASCULAR SURGERY

 

The field of microvascular surgery is relatively new, with the first operation performed in 1973.

After 25 years of development, it now holds a critical position in the care of patients. A free flap is essentially a composite block of tissue transplanted from one part of the body to another distant site where its circulation (artery and vein) is restored utilizing microsurgical techniques.

The ability to close wounds and restore form and function utilizing transplanted tissue has forever changed the modern approach to reconstruction and continues to expand the indications for surgery.

The following free flap procedures are performed at UCLA:

  • Breast: reconstruction with the free TRAM, superior and inferior gluteal flap, TFL flap, Ruben's flap, gracilis flap
  • Trunk: coverage of the abdomen and chest, specifically following large wounds typically associated with radiation therapy and cancer resections
  • Head and neck: reconstruction of the mandible, esophagus, scalp and cranial base
  • Lower extremity: free flap coverage of traumatic wounds and post-oncologic resections, salvage of amputation stumps, bony reconstruction, coverage of nonhealing lower extremity ulcers secondary to diabetes, arterial or venous insufficiency.
  • Facial re-animation: restoration of facial expression following nerve injury / cancer resections
  • Hand: wound coverage, digital replacement and reconstruction, functioning muscle transplantation.

Free flap surgery is a complex operation that requires a high degree of surgical expertise and experience. By continued refinement of techniques and a high volume of cases, we have been able to maintain a high rate of success approaching 98% patency rates.

Given the low complication rates and high success rates, this field of surgery has shifted from that of being "experimental" and "procedures of last resort" to routine and first-choice reconstructive techniques.

Continued research in the field of flap pre-fabrication and tissue engineering will continue to expand this surgical arena.

 

REPLANTATION SURGERY

 

Replantation refers to the surgical reattachment of a finger, hand, or arm that has been completely cut from a person’s body (American Society for Surgery of the Hand, 2006).Replantation surgery is the ultimate form of reconstruction following an amputation. It provides like for like composite tissue and the best chance of functional recovery.

Ultimately, the goal of replantation surgery is to give the patient back as much use of the injured area as possible.

Preservation

Should an emergency as such occur, the detached part should be placed in a clean plastic bag, and stored with a separate bag of ice, as shown below or in any of a thermal box.

 

 

 

 

 

 

 

 

 

 

   It is important that you approach a hospital that performs Reconstructive Microsurgery for immediate treatment.

         One of the most spectacular surgical procedures is the re-attachment of an amputated extremity. The procedures are known as replantation surgery. The name is similar to transplantation surgery.  In transplant surgery a body part or organ is removed from one patient and transplanted to another.  In replantation surgery a body part which has been accidentally removed is re-attached or replanted to the original patient.  All of us have read about farmers or equipment operators who have lost an arm or a leg in an accident.  Once these procedures were headline news but, with advances in medicine and the availability of surgical microscopes and microsurgical instrumentation, these procedures are now more common than you may realize.  Several factors are involved in successful replantation surgery.  The method of injury, the location of the injury, the age of the patient, the health of the patient, the method of transporting the body part and the time from injury to the time in surgery are all factors affecting the outcome.

Carotid vessel repair

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Digital level replantation

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Free Flap (RAFF) for temporal deffect

 

 

 

 

 

 

 

 

 

 

 

 

 

Free LD Flap to cover exposed tibia

 

 

 

 

 

 

 

 

 

 

 

 

Penile Replantation

 

 

 

 

 

 

 

Replantation at Elbow level

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Replantation at wrist level

 

 

 

 

 

 

 

 

 

 

 

 

 

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