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Free Tissue Transfers and Replantation

Saint-Cyr, Michel M.D.; Wong, Corrine M.R.C.S.; Buchel, Edward W. M.D.; Colohan, Shannon F.R.C.S.(C.); Pederson, William C. M.D.

Plastic and Reconstructive Surgery: December 2012 - Volume 130 - Issue 6 - p 858e–878e
doi: 10.1097/PRS.0b013e31826da2b7
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Learning Objectives: After studying this article, the participant should be able to: 1. Describe the indications and contraindications for free flap reconstruction. 2. Describe the indications, anatomy, harvest technique, and advantages and disadvantages of the workhorse free flaps. 3. Describe the indications and contraindications for extremity replantation. 4. Describe the techniques and management for extremity replantation.

Summary: Microsurgical free flap reconstruction uses a multitude of surgical flaps available to meet the needs of the recipient site. These include cutaneous, muscle, bone, fascia, or some combination of these as available options. Furthermore, sophisticated reconstruction has been enhanced by the development of perforator flaps, enabling multicomponent reconstruction to be performed with reduced donor-site morbidity. It is mandatory that proper débridement of the defect be performed before reconstruction, and that the anastomosis is performed without tension or twisting outside of the zone of injury. There are indications for both musculocutaneous and perforator flaps, and selection is dependent on recipient-site characteristics in addition to function and aesthetics of both the recipient and donor sites. Muscle flaps provide well-vascularized pliable tissue and are used for deep space obliteration, whereas fasciocutaneous flaps are used for flatter, more superficial wounds. Microsurgical replantation of an amputated extremity offers a result that is usually superior to any other type of reconstruction. However, replantation of extremities involves more than microsurgery, as repair of bony and tendon injury must be undertaken as well. This article focuses on the indications, technique, and results of free flap reconstruction and replantation.


Dallas and San Antonio, Texas; and Winnipeg, Manitoba, Canada

From the University of Texas Southwestern Medical Center; the Section of Plastic Surgery, University of Manitoba; and the Hand Center of San Antonio and the Department of Surgery, University of Texas Health Science Center at San Antonio.

Received for publication June 21, 2011; accepted January 26, 2012.

Disclosure: The authors have no commercial associations that might pose or create a conflict of interest with information presented in this article.

Related Video content is available for this article. The videos can be found under the “Related Videos” section of the full-text article, or, for Ovid users, using the URL citations published in the article.

Michel Saint-Cyr, M.D.; Division of Plastic Surgery, Mayo Clinic, 200 First Street SW, Rochester, Minn. 55905,

©2012American Society of Plastic Surgeons