Flap Surgery in Delhi, India

The following patients may benefit from flap surgery: 

1. Suffered from tissue loss 
2. Traumatic injury
3. Gone through mastectomy
4. Cancer patient
5. Damage to the skin due to burns
6. Skin cancer

In most medically fit patients, flap surgery which is major complex surgery is considered safe with a low complication rate. Although flap surgery is not avoidable in the patients where it is required, extra caution is observed in the patients with the following conditions:

1. Nutritionally weak patient
2. Serious Heart condition
3. Uncontrolled Diabetes 
4. History of medical conditions
5. Smoking
6. Bleeding disorder, anaemia or any other chronic illness

The first and foremost step to take while preparing for the surgery is to know the complete details about the flap surgery. Ask your surgeon about flap surgery in great detail, including the benefits of having the surgery and the potential risk factors. Once done, the doctor may prescribe some tests like the doppler test to examine the blood supply of the donor and recipient sites.

Other tests may include MRI, CT scan, blood tests, urine tests, X-ray, and more to get a detailed overview. Your doctor will also ask about allergies or a family history of bleeding disorders. Other preparations for flap surgery may require the following:

1. Maintaining a healthy diet
2. Quit smoking as it may delay the healing process and increase the risk of postoperative complications
3. Avoid taking anti-inflammatory drugs
4. Stop taking blood-thinning medications for a week before the surgery

• The surgeon may create two sites, one recipient site and the donor site.
• The recipient site is the defect (due to trauma, cancer, infection etc.), while the donor site is the healthy area from where the tissue is borrowed to cover the defect.
• That said, flap surgery can be broadly classified into three different categories. The surgeon may use various techniques to extract the flap. These may include:
  • Depending on the location of the flap
  • Depending on blood supply
  • Depending on tissue type

Local Flaps

In this procedure, the tissues are transferred from an area next to the recipient site. The local flaps may be further classified as:

1. Advancement flap: The advancement flap means that the flap moves directly into the recipient site from nearby. 
2. Rotation flap: In rotation flap, a semicircular flap is cut that is rotated about a pivot point into the adjacent defect. 
3. Transportation flap:The flap is moved into the recipient site over intervening intact skin
4. Interpolation flap:In this, the flap rotated around a pivot point and repositioned into a nearby area (no adjacent). The flap basically passes above or below a section of intact tissues creating a skin bridge.

Distant Flaps

1. Pedicled flap:In this situation, the flaps are transferred from a different part of the body, though it is still attached to the original blood supply 
2. Free Flap: In this, the flap is detached from its original blood supply and reattached to the recipient site with microsurgery. This is essentially a transplant surgery involving the patient's own tissues. Free flap surgery has single-handedly revolutionized the field of reconstructive surgery, especially in cancer and trauma cases.

• Axial Pattern flap: In this case, the flap comes with at least one named artery or direct cutaneous branch blood supply. 
• Random Pattern flap: The flap does not contain blood supply from a recognized artery. However, the bloody supply comes from many little unnamed blood vessels. 
• Perforator flaps: The flaps contain small blood vessels from a single large vessel.

The flap may contain a single tissue or several types. Depending on the tissues, the flap may be taken from:

1. Skin
2. Fibrous connective tissue
3. Muscle
4. Bone and skin(osteocutaneous)
5. Visceral 
6. Skin and fascia (fasciocutaneous)
7. Skin, fat and muscle (myocutaneous)

Once the surgery is done, the surgeon then sutures the recipient and donor site and applies a dressing. In some cases, the surgeon may also put a drainage tube to move the excess fluid from the surgical site.

Flap surgery is a complex surgery. Like any other major surgery, it also poses risks and complications like infection, bleeding, and blood clots. Other complications may include:

1. Scarring
2. Excessive bleeding
3. Flap failure
4. Seroma 
5. Skin or fat necrosis
6. Problem with donor site
7. Swelling
8. Fluid accumulation

Major flap surgeries may need ICU care for 2 days. After the surgery, one may feel some soreness and pain at the incision site for a few days. The doctor will prescribe medications for the pain. One will be encouraged to get out of bed and go for short walks as soon as possible. The doctor will provide a postoperative plan to ensure a speedy recovery. These may include:

1. Rest for several days after the surgery
2. Keep the dressing and surrounding area clean
3. Take medicines prescribed by the doctor
4. Do not smoke or consume alcohol few weeks after the surgery
5. Try to elevate the wound while sleeping
6. Avoid physical activities that may stretch or injure the flap