Microsurgery: Free Tissue Transfer
Free Tissue Transfer is one technique for micro reconstruction surgery that aims to repair the space left in your body after a tumor is removed. In simple terms, tissue is transferred from one part of your body (called as the donor site), to the area that needs reconstruction (recipient site).
Once your primary surgeon deems the tumor and the affected bone(s) and soft tissue(s) are fully removed, your reconstructive surgeon will take what we call a ‘free flap.’ This refers to any block of skin, tissue, muscle, or bone from the donor site which will be attached to the recipient site. A microscope will be used to connect the tiny blood vessels in the free flap with the blood vessels at the recipient site. This is done with thin sutures. In cases when a vein is needed to integrate the free flap into the recipient site, your surgeon will make a small incision on a donor site - usually from your arm or leg.
Other scenarios would require a skin graft (taken from your buttock or thigh) to cover your donor and/or recipient site. Skin grafts are often done as well for post-burn treatment.
Please be reminded that all cases are unique. Microsurgery is something that can be done in different ways.
Preparation
After all tumors and high priority concerns have been resolved, you will have a consultation with your reconstruction surgeon. You will be advised about your next steps for your treatment plan.
a. You may be recommended to have a medical clearance visit to lower potential risks pertinent to the reconstructive surgery as much as possible.
b. You may undergo tests for your:
Heart
Lungs
Blood vessels in your legs (through an angiogram)
c. You may also advised to have other tests like:
Computed Tomography (CT) scan
Magnetic Resonance Imaging (MRI)
X-rays
Consultation with other specialists may be required based on the area that will undergo the reconstructive surgery.
Be honest with your surgeon about your alcohol and smoking habits. These are two factors that may cause complications during and after the surgery. In this way, your surgeon will be able to help you if you’re unable to stop right away for risk of withdrawal.
Healing and Recovery
We recommend our patients to rest and take it easy during this time, avoiding any movements that may cause strain to the treatment area to prevent any complications. The following week after the surgery, swelling and pain may be experienced which should naturally go away over time.
Post-care instruction will also vary depending on the area(s) that was treated. Your surgeon will be providing your personalized self-care guidelines. Be sure to ask if anything is unclear.
Setting Expectations
Reconstructive surgeries often come with both temporary and permanent changes. It’s important that you are well aware of possible outcomes such as changes in your:
Appearance - You may have scarring at the donor and/or recipient sites. The free flap may be a different color than your surrounding skin.
Lifestyle - Some things you can do before the surgery may no longer be possible. This is dependent on where the flap is located.
Ability to swallow or eat some types of foods.
Speech, if your surgery was done in your mouth.
Ability to speak, if your surgery was done on your voice box.
Sensation on the skin at your surgical sites. These will improve over time, but they may always feel more numb than your untreated skin.
IMPORTANT NOTE:
Following health and safety guidelines, your surgeon may advise you to provide thorough information on your medical history. In this time of COVID-19, appropriate testing will be required prior to the procedure.
References:
Memorial Sloan Kettering Cancer Center. “About Your Microvascular Reconstruction Surgery Using Free Tissue Transfer.” 8 November 2017, https://www.mskcc.org/cancer-care/patient-education/microvascular-reconstruction-free-tissue-transfer. Accessed 23 December 2020.
Sakurai, Hiroyuki. “Microvascular technique of composite tissue transfer.” Total Burn Care, 4th Edition ed., Saunders, 2012.