Free Flap Reconstruction

Free Tissue Microvascular Surgery Overview

Free Tissue Microvascular Surgery, also known as free flap surgery, ranges from minimally invasive procedures (tissue rearrangement, cartilage grafting, rotation flaps and skin grafting techniques) to large areas that require extensive repair (head and neck reconstruction)—to restore the appearance to a natural state. 

Microvascular free tissue transfer, also known as free flap surgery, of the head and neck is a complex reconstructive surgical procedure used to restore form and function to the head and neck region following cancer resection or trauma. It involves the transfer of living tissue, such as skin, muscle, bone, or a combination of these, from one part of the body (donor site) to the head and neck region (recipient site). 

Microvascular free flap surgery offers several advantages in head and neck reconstruction. It allows for precise tissue matching, enables larger and more complex reconstructions, provides better functional outcomes, and reduces the risk of complications such as wound breakdown or infection.

However, it is a highly specialized procedure that requires expertise in microsurgery techniques and a multidisciplinary approach. Dr. Rahul Seth is an expert in free flap surgery, having performed over 500 free flaps while on faculty at UCSF. He has high success rates and low complications, and his outcomes have been published in peer-reviewed journals. He has published over 50 papers and advanced research in the field of reconstruction. Further, as an expert surgeon, he has trained numerous surgeons in the art of reconstruction.


You may be a good Free Tissue Microvascular Surgery candidate if you:

  • Have large areas that require extensive repair
  • Require rehabilitating surgical defects caused by the removal of head and neck tumors
  • Are physically healthy
  • Are a non-smoker


Here’s an overview of the procedure:

  1. Preparation: The patient is evaluated by a multidisciplinary team, potentially including a head and neck surgeon, Mohs dermatologic surgeon, facial plastic and reconstructive surgeon, and anesthesiologist. Imaging studies and other diagnostic tests are conducted to assess the extent of the defect and plan the reconstruction. 
  2. Donor Site Selection: The choice of donor site depends on several factors, including the size and location of the defect, the desired tissue type, and the patient’s overall health. Common donor sites include the forearm (radial forearm flap), the lower leg bone (fibula flap), the thigh (anterolateral thigh free flap). 
  3. Surgical Procedure: The surgery is performed under general anesthesia. The selected flap, including its blood vessels, is carefully harvested from the donor site, preserving its blood supply. The blood vessels are then meticulously connected to recipient blood vessels in the head and neck region using microsurgical techniques. This allows the transferred tissue to receive a new blood supply at the recipient site. This allows the flap to be “alive” in its new location. Since it is your own body part, there are no issues with rejection. 
  4. Reconstruction and Closure: Once the flap is successfully transferred and blood circulation is established, the surgeon shapes and positions the tissue to reconstruct the defect. This may involve reconstructing soft tissue defects, bone defects, or both, depending on the extent of the resection. The surgical site is then closed using sutures or other closure techniques.
  5. Recovery and Rehabilitation: After the surgery, the patient is closely monitored in the hospital for several days. The reconstructed area requires careful postoperative care, including monitoring blood flow to the flap, managing pain and swelling, and ensuring appropriate wound healing. Physical therapy and rehabilitation may be necessary to optimize functional outcomes.


Following surgery patients are often sedated for the first night and awoken the next morning. Patients will typically remain in the intensive care unit for about two days before moving to a regular room. 

Recovery will vary from patient to patient and is largely dependent upon the extent of underlying surgery.  Dr. Seth will provide a thorough explanation of your unique recovery process, including information about any swelling and bruising to expect, pain management, or diet/activity restrictions.  Prior to hospital discharge, each patient is assessed by a physical therapist to determine if there is a need for transfer to a rehabilitation hospital or if you will require at-home nursing care.

How To Get Started

If you’re interested in Microvascular Free Flap Reconstruction or want to learn more about your options with Dr. Rahul Seth, please request a consultation online or by phone at (925) 357-9050.

During your consultation, you will have time to discuss your goals and treatment options. During this process, you will get to know Dr. Seth and the Golden State Plastics team that will be with you every step of your journey. Once your consultation is complete and your unique treatment plan is created you will work with the Golden State Plastics team to schedule surgery. Once your surgery is scheduled, you will receive a pre-operative appointment to review your procedure, post-operative instructions, and expectations on your road to recovery.

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