by admin-blog-kh | December 10, 2025 7:29 am
Free flap surgery is a reconstructive procedure often used for patients with head and neck cancer[8], after tumour removal. It involves transplanting tissue from one part of the body to another while maintaining the tissue’s blood supply. This flap may consist of skin, fat, fascia or a combination of the three. The free flap is reconnected at the recipient site through a process called anastomosis, typically done under a microscope. The surgery aims to restore both functionality as well as an aesthetic appearance. Free flap surgery has a high success rate when performed by a qualified and experienced plastic surgeon. It is also commonly used in the treatment of advanced burns, traumatic injuries and congenital defects.
Patients diagnosed with cancer in the head or neck often require surgical treatment. The cancerous tumour must be removed. Removal of tumours in the mouth and throat can affect day-to-day functions like the ability to speak or swallow. They can also cause significant alteration in the patient’s physical appearance. Often, the wounds caused by tumour removal are very large and need to be surgically reconstructed. This can be done using free flaps.
A flap is a unit of tissue that is transplanted from one part (donor site) of the body to another (recipient site). This flap of tissue retains its blood vessel network. The flaps can be made of one or more types of tissue including skin tissue, fatty tissue and fascia. Free flap surgery is a sub-specialty of reconstructive plastic surgery.
In some instances, tissue may be transferred from an area adjacent to the defect. In such cases, the major artery supplying blood to the flap is not disconnected but kept intact. Usually, the tissue flap is rotated or transposed around the axis of the blood supply and used to cover the wound. However, this is not always possible as it is dependent on the vascularity of the tissue in question, i.e. whether it is possible for the artery to remain connected during relocation. In such cases, free flaps are used. The blood vessels of the flap are physically detached and relocated to the recipient site. They need to be reconnected to another artery for blood supply at the recipient site. The process of reconnecting the blood vessels is called anastomosis. This anastomosis is usually performed using a microscope.
The main goal of free flap reconstruction is to regain function and restore physical appearance. In order to accomplish this, the surgeon will choose the donor site carefully. He will select the tissue that most closely matches the function and physical appearance of the tissue that was removed. For example, free flaps are commonly taken from the forearm or thighs (thin skin) to reconstruct the insides of the mouth and throat. Free flap surgery for head and neck cancer has a very high success rate when performed by a qualified and experienced surgeon. Advancements in the field of microvascular surgery have also improved patient outcomes in recent years.
Patients with head and neck cancer are frequently recommended free flap surgery for reconstruction after tumour removal. Burn victims are also recommended free flap surgery for treatment of 3rd degree burns. It is also a viable technique for reconstructing congenital defects and diabetic foot. Free flaps are also used to treat trauma patients, especially those who have sustained facial trauma, severe burns and jaw injuries.
Free flap surgery with anastomosis is a prolonged surgical operation. If you have any medical condition that would put your body at risk when under anaesthesia for long periods of time, free flap surgery might not be recommended for you. This includes a history of excessive bleeding or blood clots (coagulopathy), uncontrolled diabetes and cardiac issues. Geriatric adults and patients who are unfit for surgery in general are also not recommended free flap surgery. Your reconstructive surgeon[10] will review your medical history and general health before advising you on the best reconstruction option.
Advantages of
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Disadvantages of
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Free flap surgery has both aesthetic and functional advantages: |
Any surgical intervention always has certain risks associated with it. Free flap surgery is no exception to this. Below are some of the disadvantages of free flap surgery: |
| Stable and Sturdy Coverage – The flap will cover the wound well, with low chances of the flap breaking or getting damaged. | Flap Failure – Sometimes, the donor tissue flap undergoes necrosis or tissue death before the blood supply can be re-established at the recipient site. |
| Good Tissue Match – It is possible to choose better skin flaps that match the recipient site in skin colour, contour, etc. | Long Hospitalization & Recovery – The patient has to stay in the hospital for constant monitoring, in case of complications. |
| Healthy Tissue is Used – There is flexibility to choose a healthy donor site with good vascularity. This helps combat infection and accelerates healing. | Bulky Flaps – Sometimes, the free flaps may be a little thick. This could form adhesions. The patient may require a follow-up surgery to remove the adhesions. |
| Restores Function – Using free flaps, functioning muscles like the ones used to smile can be successfully reconstructed. | |
| Restores Aesthetics – Free flaps provide an improved aesthetic appearance, covering burn scars, tumour removal sites, developmental deformities or traumatic injury scars. |
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Before free flap surgery, the patient is given general anaesthesia, so that he/she won’t feel any pain during surgery. During surgery, the tumour or damaged tissue is removed carefully. The free flap is then harvested from the donor site with its healthy blood vessel and nerve network. Then, special microscopes and surgical tools are used to perform anastomosis. For optimal results, the patient may have to undergo several surgeries, spaced apart, to allow the tissue to heal and settle naturally.
After the surgery, the patient must stay at the hospital for monitoring for about a week. The doctors and nurses will be on the lookout for signs of infections, necrosis, or any other complications. The surgical wounds will have to be cleaned and dressed carefully. The reconstructive surgeons will instruct patients on how to care for the wounds at home as well. If you are experiencing pain at the surgical site, consult your doctor about pain killers or applying ice to the area. The dressing must be kept dry at all times.
As the patient heals, they may also be recommended functional physiotherapy to regain function in the reconstructed muscles. For example, patients who have had mouth or jaw surgery may require physiotherapy to re-learn how to chew and swallow safely. It is also very important to go back to the hospital for follow-up. It is also recommended to avoid strenuous exercise and hitting or bumping the area until the wound is completely healed.
If you or a loved one are considering free flap surgery for reconstruction and recovery, expert care is crucial. Kauvery Hospital, with branches in Chennai, Hosur, Salem, Tirunelveli, and Trichy, offers advanced reconstructive surgery and comprehensive support to help you restore function[12] and confidence with compassionate, specialized care.
What is free flap surgery?
Free flap surgery is a reconstruction method where healthy tissue with its blood vessels is moved from one part of the body to another. The vessels are reconnected under a microscope to help the tissue survive and heal.
Why is free flap surgery used in head and neck cancer?
It helps rebuild areas affected after tumour removal, restoring appearance and important functions like speaking, chewing, and swallowing.
How long does recovery take after free flap surgery?
Most patients stay in the hospital for a week for monitoring. Full healing may take weeks to months, depending on the size of the reconstruction and overall health.
Is free flap surgery safe?
Yes, it is considered safe when performed by an experienced reconstructive surgeon. Like any surgery, risks include infection, flap failure, or delayed healing.
Who is not a good candidate for free flap surgery?
People with uncontrolled diabetes, severe heart issues, poor vascular health, or those not fit for long surgeries may not be suitable.
Will I need physiotherapy after free flap surgery?
Yes, some patients need physiotherapy to regain normal movements like chewing, swallowing, or facial expressions.
How successful is free flap surgery?
Success rates are high due to advances in microvascular techniques and the experience of modern reconstructive surgeons.
Where can I get expert care for free flap surgery?
Kauvery Hospital[13] offers advanced reconstructive services with skilled surgeons and complete post-operative support for safe recovery.
Kauvery Hospital is globally known for its multidisciplinary services at all its Centers of Excellence, and for its comprehensive, Avant-Grade technology, especially in diagnostics and remedial care in heart diseases, transplantation, vascular and neurosciences medicine. Located in the heart of Trichy (Tennur, Royal Road and Alexandria Road (Cantonment), Chennai (Alwarpet, Radial Road & Vadapalani), Hosur, Salem, Tirunelveli and Bengaluru, the hospital also renders adult and paediatric trauma care.
Chennai Alwarpet – 044 4000 6000 • Chennai Radial Road – 044 6111 6111 • Chennai Vadapalani – 044 4000 6000 • Trichy – Cantonment – 0431 4077777 • Trichy – Heartcity – 0431 4077777 • Trichy – Tennur – 0431 4022555 • Maa Kauvery Trichy – 0431 4077777 • Kauvery Cancer Institute, Trichy – 0431 4077777 • Hosur – 04344 272727 • Salem – 0427 2677777 • Tirunelveli – 0462 4006000 • Bengaluru – 080 6801 68011
Source URL: https://www.kauveryhospital.com/blog/cancer/preparing-for-free-flap-surgery-a-comprehensive-patient-guide/
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