Lior Heller L Scott Levin Introduction

Autologous tissue transplantation describes the surgical technique to transfer tissue from one location in the body to another using the operating microscope and techniques of microvascular surgery to perform small vessel anastomoses.

Reconstructive microsurgery began more than three decades ago with the introduction of the operating microscope for anastomosis of blood vessels, described by Jacobson and Suarez.1 Beginning with microsurgical repair of digital arteries and digital replantation in the 1960s2,3 microsurgical composite tissue transplantation began in the 1970s. Microsurgeons expanded their efforts from achieving tissue survival to include the improvement of function as well as appearance in the 1980s. In the 1990s, the emphasis has shifted to outcome. Today, composite transplantation or free tissue transfer routinely provides not only coverage but facilitates function.

Microsurgical reconstructive procedures became an integral part of almost all the surgical fields. For example, in orthopedics, the simultaneous management of fractures and associated soft-tissue injury the so-called "orthoplastic approach" is now accepted treatment for extremity trauma. It allows for optimal repair processes to take place for bone and soft tissue while avoiding the adverse sequelae of failed fixation, sepsis, and ultimately amputation.

Free flaps include isolated transfer, composite tissue transfer, and functioning free muscle transfer. Structural transfers such as vascularized bone grafts or toe transplantation for hand reconstruction as well as specific tissue transfers such as vascular and neural grafts are also an integral part of the microsurgical reconstruction armamentarium. While such "grafts" do not involve large amounts of tissue, it is considered tissue transplantation and thus is included as a free tissue transfer. In this Chapter we will concentrate on the most common flaps used for reconstruction.

Free tissue transfer procedures are by nature technically complex. This is due in part to the fact that no two reconstructive cases are exactly alike. The surgical solution tends to vary from case to case in the location, amount, and types of tissue that need to be replaced. Another distinguishing characteristic is that free flap reconstruction is a three-dimensional process that requires considerable preoperative planning. The best donor site must be chosen and the flap precisely designed so that it fulfills the needs at the recipient site.

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