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Free Flaps

    What Is Primary Closure?

    Primary closure is the simplest type of reconstruction and involves simply bringing the edges of a wound together. This can be all that is needed following a small cut or injury to the head, neck, or face region.

    Preparation For Surgery

    You will meet with Dr. Mourad where he usually spends an hour going over everything related to your surgery. He will evaluate and make sure that he can specifically tailor a custom care plan to your exact needs. During the consultation, Dr. Mourad will determine the exact nature of your complaints and the exact causes. He may prescribe medications that will assist in your complaints. Once a tailored plan is made, Dr. Mourad and his staff will take you through all the necessary information needed to make sure that your surgery happens without issue. We take care of the details so that you can have the most enjoyable experience.

    Dr. Mourad views treating his patients to be nothing short of a privilege and an honor and enjoys taking the time to get to know his patients and fully understand their issues. Dr. Mourad’s office provides a boutique experience that takes you out of the mindset of being at the doctor’s office. It is a warm, comfortable environment, providing a bespoke experience.

    What Is A Local Flap?

    Local flaps are a type of reconstruction in which tissue needed to close a defect is borrowed from a “neighboring” area. An example would be moving the skin overlying the cheek to close a hole on the nose. It is called “local” because the surgeon uses tissue in the immediate area surrounding a defect to close the defect. There are many different types of local flaps depending on how they are designed and where tissue is obtained. But local flaps are very often used in the reconstruction of simple defects of the head and neck region.

    Types of Local Flaps

    Transposition-Flap

    Transposition Flap

    Rotation-Flap

    Rotation Flap

    Advancement-Flap

    Advancement Flap

    What Is A Regional Flap?

    A regional flap is a method of reconstruction whereby tissue is obtained from an area slightly further away from the immediately neighboring tissue that surrounds the defect. This makes it different from a local flap and represents a slightly more complex reconstruction. A common example is using the tissue from the chest wall including the pectoralis muscle to reconstruct a hole in the cheek. There are many types of regional flaps that are classified differently that are used for many different purposes.

    What Is Free Grafting?

    Free grafting is a process in which tissue used for repairs of holes and defects is obtained from a different part of the body. The “grafts” obtained are placed in a new area that is being repaired. An example would be using a piece of ear cartilage and skin to fix a part of the nose that is missing.

    What Is A Free Flap?

    Microvascular free tissue transfer is what is commonly referred to as a “free flap”. It is a complex reconstructive surgical procedure that allows for the transplantation of tissue from one part of the body to another. It is based on the same principles as a transplant in which living tissue is harvested and placed along with new blood supply in a new site. The difference between a regular organ transplant, and a free flap, is that free flaps use your own body’s tissue for transplantation. However, it requires the same techniques required to restore and reattach blood supply at the new site as a regular organ transplant. Free flaps allow for the reconstruction of complex defects that involve major tissue loss to better restore form and function. Free flaps are most commonly performed in breast and extremity reconstruction, in addition to head and neck reconstruction. An example would be using a piece of the bones in the leg to fashion and make a new jaw.

    What Are Free Flaps Used For?

    A free flap may be recommended if you require major reconstruction following surgery, trauma, removal of cancer, or correction of congenital deformities. In the face, head, and neck, free flaps are most commonly used to restore form and function following major cancer surgery that required removal of vital structures. For example, free flaps can help reconstruct jaw and face defects that were involved with tumor. Free flaps are performed by highly specialized surgeons, with advanced training in the field. If you are considering free flap surgery be sure to seek consultation with an expert in the field.

    What Types Of Free Flaps Are There?

    Free flaps are classified by the site of tissue donation. Some examples include:

    • Anterolateral thigh free flap: skin and fatty tissue are donated from the thigh region.
    • Radial Forearm Free Flap: Skin is harvested from the forearm along with its arterial blood supply. Sometimes this free flap may include a small portion of wrist bone if bony reconstruction is required.
    • Fibula Free Flap: Skin and fibular bone is removed from the calf region and used to reconstruct bony defects. This is most commonly used in the reconstruction of the jaw defects.
    • Scapular Free Flap: Skin and bone from the shoulder blade used for transplantation and reconstruction of bony defects.
    • Abdominal Free Flaps (TRAM, DIEP, SIEA Flaps): Fat and skin are harvested from the abdominal region. Sometimes this may include portions of muscle if required.
    • Latissimus Dorsi Free Flap: Back muscle along with skin and fat are transplanted for reconstruction.

    What Are The Risks To Free Flap Surgery?

    Given the complexity of transplanting tissue, you should be aware of certain risks. Common complications include bleeding, infection, transplant failure, fluid or blood collection, or tissue death (necrosis). The risk of complications may be increased if you have had radiation or are an active smoker. It is important to consult with your surgeon with regards to these risks prior to your surgery.

    What Is The Recovery Like Following Free Flap Surgery?

    Free flap surgeries usually require a hospital stay of about 6-7 days following the surgery. This is to ensure that there is no tissue death or transplant failure and to allow for observation and enhance your recovery. Depending on the specific free flap surgery and the nature of the reconstruction, some patients may require additional physical therapy and rehabilitation. This is particularly important in patients with the reconstruction of the head and neck region, as speech and swallow therapy is often times used to enhance outcomes.

    Why You Should See Dr. Mourad With Regards To Your Head And Neck Reconstruction And Free Flap Needs?

    Dr. Mourad has extensive training in the highly specialized field of free flap surgery, as well as head and neck reconstruction. Currently, he serves as the Chief of Head & Neck and Microvascular Reconstructive Surgery at the James J. Peters Hospital in New York City. He has pioneered many new techniques that have been featured and published in scientific and medical journals. He has more than 20 publications in the field of head and neck reconstruction, establishing him as a leader in the field. With his extensive knowledge and background, he can best tailor treatment to your specific needs.

    Meet Dr. Moustafa Mourad, MD, FACS

    Moustafa Mourad, MD, FACS is board-certified in head and neck surgery and highly-trained in cosmetic plastic surgery and facial reconstruction. Dr. Mourad is also a Fellow of the American College of Surgeons. He treats many conditions, both cosmetic and complex, that affect the head, neck and entire facial area. Learn More »

    Select Relevant Publications

    Kadakia S, Mourad MW, and Ducic Y. Supraclavicular Flap Reconstruction of Cutaneous Defects Has Lower Complication Rate than Mucosal Defects. Journal of Reconstructive Microsurgery. 2017 May; 33(4):275-280. Link to Article.

    Moubayed S, Mourad MW, Lee T, and Ducic Y. An Overview of Regional Tissue Transfer for Head and Neck Reconstruction. Head and Neck Cancer. 2016 Feb. Link to Article.

    Mourad MW, Moubayed S, Inman J, and Ducic Y. Microvascular Reconstruction of the Head and Neck. Head and Neck Cancer. 2016 Feb. Link to Article.

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