Free Flap/Flap Takeback

A free flap involves transplanting tissue from one part of the body to another with its blood supply to reconstruct a defect, while flap takeback refers to the surgical procedure of re-evaluating and potentially reattaching a flap if initial outcomes are unsatisfactory.

01 - Patient Setup

Pre-op Meds: Ancef, Clindamycin if PCN allergy

Anesthesia:  General

Patient position: Varies

Bed position: No turn

DVT ppx:  Compression boots on - working BEFORE induction of anesthesia

Side Table: N/A

Lights: Overhead, headlamp

Power: 2-4 Bovie Machines

Bovie Settings: 30/30; bipolar 20

Preinjection: None

Prep:   Vs betadine 

Drapes: split drapes

Instrument sets:   Red microsurgery cart, pink plastic surgery cart

02 - Case Details 

Special Instruments: Mitaka microscope, fluid warmer, heparinized saline (must be kept in the warmer, can be made with 10,000 units of heparin in 100 cc of injectable normal saline for final concentration of 100 units/cc), papaverine, Koven doppler on the field, anterior chamber needle, Weck-Cel, neuropatty, fishhook/lonestar. 

*The remaining special equipment can be opened on an as-needed basis (coupler, background, vessel loop, etc., these are all found in the red microsurgery cart)*

Devices/Implants: venous coupler

Hypodermic needles:  N/A

Syringes: 21-gauge Angiocath, anterior chamber needle

Drains: 2#15 Blake Drains (unopened)

Suture: 8-0 nylon, 2-0 PDS CT1, 2-0 nylon

Anesthesia on field: None

Dressing:  varies

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03 - Post-Op Information

Admission status: Inpatient

Estimated time: 6 hrs

Coding:  15756/15757

Post-op wound care:  Varies

Post-op activity restrictions:  No heavy activity for 24 wks

Follow up:  1 wk

Post-Op Instructions obtain from MedConnect

04 - HY Tips

Typically performed overnight with potentially unfamiliar team members, booking the case as a free flap formation (CPT 15757) ensures access to a pick list with all necessary equipment.

Draping Tips

• Prep as wide as possible

• When toweling off the surgical field and apply drapes, maintain the wide field and not make it smaller with each additional layer

• Dr. Tom does not use any instrument to clamp movie and section (just staple drapes together) to avoid count being off

• Do not let the place the movie holder in the way of the surgeon (e.g. not on R side next to patient)

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Tips for Set-Up:

1. Ensure the patient is wheeled to the operating room as soon as possible; assist with minimal setup to expedite the process, acquiring additional materials once the patient is in the room.

2. Confirm with the attending if the leg should be prepped for possible vein graft harvest.

3. Ensure a micro set is available; it’s crucial. If SPD cannot locate one, check the cart or shelf outside ORs 5 and 6 for an extra set.