Plastic Surgery microsurgical free graft

Microsurgical Free Flap Transfers

Objectives

•   Reconstruction of defects 

•   By transfer of a flap from a distant area wherein the artery and vein supplying the flap is anastomosed to an artery and vein in the recipient area 

•   Under magnification with an operating microscope

•   Operation may be done by two teams simultaneously.

Position

Depending upon the site of recipient and donor areas.

Anesthesia

General.

Procedure

1.  Clean and drape recipient and donor areas.

2.  Prepare recipient area.

3.  Dissect and prepare recipient artery and vein.

4.  Plan and flap.

5.  Raise and prepare the flap and dissect its artery and veins.

6.  Divide flap vessels, transfer flap to the recipient area.

7.  Anastomose the vessels/Close recipient area by direct closure or skin grafting.

Instruments

•   Plastic surgery set 

•   Skin grafting set 

•   Microsurgery set consisting of: 

     a.  Jewellers forceps No. 2                   2   

     b.  Jewellers forceps No. 5                   2

     c.  Vessel dilator                                  1 

     d.  Curved blunt tipped dissecting    1
microscissors 

     e.  Straight sharp microscissors          1

     f.   Microneedle holder straight          1
or curved 

     g.  Microvessel clamps                         4 

     h.  Microvessel approximator clamps   2 

     i.   Visibility background                     1

     j.   Fine suction tip                              1

     k.  Irrigation syringe with                    1
22 G venflon 

     l.   Operating microscope                    1

     m. Sterile knobs for microscope (set) 1

     n.  Microsurgical cellulose swabs

     o.  Heparin saline solution (N saline 50 mls + heparin 5000 units + xylocaine 2% 5 mls). 

Sutures

•   As for general plastic surgery 

•   10 ‘0’ Nylon on 6 mm curved round body needle or 9 ‘0’ nylon on 6 mm curved round body needle.

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