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Free Grafts

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. These types of grafts are called “free” because they are taken separately from a distant part of the body. An example would be using a piece of ear cartilage and skin to fix a part of the nose that is missing.

What Is Free Grafting Most Commonly Used For?

Free grafting is typically used to repair areas of the body that have been damaged. This type of damage can be a direct consequence of many things including trauma, surgery, scarring, cancer, or congenital birth defects.

Preparation For Free Grafting

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.

How Is Free Grafting Performed?

The site that receives the graft requiring reconstruction is referred to as the “recipient site”. The area that forms the new tissue used to reconstruct the damaged tissue is referred to as the “donor site”. Depending on the needs of the recipient site, tissue can be harvested from different donor sites. Surgeons try to follow the principle of “replacing like with like”, i.e. using similar tissue to replace the type of tissue damaged. For example, if the recipient site is composed of damaged or missing skin, it should be replaced using skin from the donor site. Ideally, the recipient and donor site should have similar qualities and appearance.

What Are Commonly Performed Free Grafts?

There are several types of free grafts that are used in head and neck reconstruction, taken from various donor sites.

Skin Grafts

A skin graft is a type of free graft composed only of skin from a donor site. There are two types of skin grafts, full thickness skin grafts and split-thickness skin grafts. These two types of grafts differ based on the thickness of the skin taken. Skin grafts can be donated from various portions of the body. Most commonly, skin is taken from the region in front of the ear, region above the clavicle, the stomach, or the thigh.

Fat Grafts

Fat grafts help to provide volume to areas that are damaged and sustained volume loss. This may be due to surgery, or simply as a part of aging. Fat grafts are commonly donated from the thigh or abdominal region.

Cartilage Grafts

Free cartilage grafts are used to repair regions that require extra structural support and more strength, most commonly used in nasal valve and rhinoplasty procedures. Cartilage grafts are typically obtained from the nasal septum (the middle portion of the nose), ear cartilage, or taken from the rib cage. Learn more about the use of rib cage in our rib grafting article.

Composite Grafts

Composite grafting is a type of graft that refers to “combination” grafts. These type of grafts may include skin AND cartilage that are needed for reconstruction. Composite grafts are most commonly obtained from the ear.

After Surgery and Recovery

Depending on your work, Dr. Mourad typically recommends taking a minimum of 3 days off before returning to work. He also discourages his patients from any heavy lifting as this can alter the structure of the nose through straining. If you wear glasses, you may require some alterations as to not provide pressure on the nasal bones if applicable. Dr. Mourad will provide you with pain medications, ointments, nasal sprays, all to help maximize your results.

You will see Dr. Mourad one week after surgery where he will remove all casting materials and splints.  Depending on the patient this swelling typically lasts for 2-3 weeks but can last up to two months in rare circumstances. To help reduce the swelling Dr. Mourad will re-apply tape to areas that will be there until your second post-operative visit. This pressure dressing reduces the amount of swelling. The second postoperative visit will involve removing all the tape. Dr. Mourad will then see you in visitations two weeks later, and then one month after that. Dr. Mourad enjoys the continued visitation of his patients and will see them in follow up for many years thereafter.

What Are Some Concerns With Free Grafting?

Free grafting is a valuable part of head and neck reconstruction and is the treatment of choice for many defects and deformities. However, free grafts are avascular, meaning that they do not have their own blood supply. Consequently, they must receive a new blood supply at the recipient site. This process begins within the first few hours of placement of a new graft and continues over the course of 1 week. This period of new blood vessel growth is vital for the survival of free grafts. Healing may be impaired by underlying medical conditions (e.g. diabetes), infections, or even smoking. It is important to make sure that the recipient site remains clear, that you quit smoking, and that all medical conditions are optimally managed to ensure the survival of the graft.

Why you should see Dr. Mourad with regards to your head and neck reconstruction and free flap needs?

Dr. Mourad is highly skilled and trained in the art of free grafting and head and neck reconstruction. He is the Chief of Head & Neck and Microvascular Reconstructive Surgery at the James J. Peters Hospital in New York City. He is not only trained in free grafting but a wide range of other reconstructive techniques, being able to tailor his services to your specific needs. When seeking a reconstructive surgeon, it is important to find one that is trained in a wide range of techniques and procedures required to provide an elevated level of care.

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

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.

Mourad M, Vincent A, and Ducic Y. Safe Autologous Rib Harvest in Patients with Breast Implants. Presented at: 12th International Symposium of Facial Plastic Surgery. 2018 October 18; Dallas, TX, USA. Link to Article.

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