Microvascular free flap reconstructions

Microvascular Free-Flap Reconstructions

Microsurgical Precision for Jaw Restoration

Microvascular free-flap reconstruction uses the patient’s own tissue—bone with or without overlying skin and muscle—harvested from a distant site and transferred to rebuild defects of the mandible or maxilla created by tumor resection or trauma. Common donor sites include:

Fibula: provides long, straight bone ideal for mandibular continuity and future dental implants.
Radial Forearm Free Flap (RFFF): offers thin, pliable skin paddle for intraoral lining and moderate bone length when osteotomized.
Anterolateral Thigh (ALT): supplies ample soft tissue bulk and optional fascia for oral or facial contour.
Scapula: yields versatile bone segments with robust soft-tissue paddles, suited for complex three-dimensional defects.

Personalized Treatment Plan:

Dr. Singhavi begins with high-resolution CT angiography and virtual surgical planning (VSP) to map both the defect and the donor vessels. He selects the donor site based on:

Defect characteristics (length, need for soft tissue vs. bone),
Patient anatomy (vascular pedicle size, limb function), and
Rehabilitation goals (timing of dental implants, facial contour requirements).

Intraoperatively:

Flap Harvest – Following VSP cutting guides, the flap is elevated with its vascular pedicle.
Defect Preparation – Tumor-free margins are confirmed, and recipient vessels (typically the facial or superior thyroid artery and vein) are prepared.
Anastomosis – Under the operating microscope, arterial and venous anastomoses reconnect blood flow.
Inset & Fixation – Bone segments are shaped and fixed with plates and screws; soft tissue is draped to restore the oral lining or facial contour.

Postoperatively, patients are monitored closely in an ICU setting for flap perfusion using both clinical checks and Doppler ultrasound. Early physiotherapy and nutritional support begin within days.

Benefits :

Restored Continuity: Seamless jaw reconstruction allows immediate restoration of dental arch stability and chewing function.
Single-Stage Procedure: Combines resection and reconstruction, reducing overall treatment time.
Optimal Aesthetics: Custom shaping and inset deliver natural facial contours.
Durable Outcomes: Vascularized bone integrates reliably, supporting future implants and long-term oral function.
Minimized Morbidity: Donor-site function (leg, arm, thigh, or shoulder) is preserved with careful surgical technique.