WordNet

unconstrained or not chemically bound in a molecule or not fixed and capable of relatively unrestricted motion; "free expansion"; "free oxygen"; "a free electron"
people who are free; "the home of the free and the brave" (同)free people
free from obligations or duties (同)discharge
free or remove obstruction from; "free a path across the cluttered floor" (同)disengage
grant freedom to; free from confinement (同)liberate, release, unloose, unloosen, loose
not literal; "a loose interpretation of what she had been told"; "a free translation of the poem" (同)loose, liberal
make (information) available for publication; "release the list with the names of the prisoners" (同)release
able to act at will; not hampered; not under compulsion or restraint; "free enterprise"; "a free port"; "a free country"; "I have an hour free"; "free will"; "free of racism"; "feel free to stay as long as you wish"; "a free choice"
not held in servitude; "after the Civil War he was a free man"
not occupied or in use; "a free locker"; "a free lane"
pronounce with a flap, of alveolar sounds
a movable airfoil that is part of an aircraft wing; used to increase lift or drag (同)flaps
any broad thin and limber covering attached at one edge; hangs loose or projects freely; "he wrote on the flap of the envelope"
the motion made by flapping up and down (同)flapping, flutter, fluttering
a movable piece of tissue partly connected to the body
move noisily; "flags flapped in the strong wind"

PrepTutorEJDIC

(束縛された状態になく)『自由な』,自由の身の / (国家・国民などが)『独立している』 / (思想・行為などが)強制されない,自発的な / (動作が)拘束されない,無理のない / 《補語にのみ用いて》(苦痛・制約などを)『免れている』,(誤り・偏見などの)ない《+『from』(『of』)+『名』》 / 《補語にのみ用いて》《『be free to』do》『自由に』…『できる』 / (仕事から)解放された,暇になった;(部屋などが)使用されていない,空いた / 『無料の』;無税の / 出し惜しみしない / 遠慮のない,慎みがない / (道路などが)障害のない,自由に通れる / 固定していない,離れた / 無料で / 自由に,妨げられずに(freely) / (…から)〈人・国など〉‘を'『自由にする』,解放する《+『名』+『from』+『名』》 / (困難などから)〈人〉‘を'救う《+『名』+『form』+『名』》 / (障害などを)〈人・物〉‘から'取り除く《+『名』+『of』(『from』)+『名』》 / (物を)…‘から'片付ける,外す《+『名』+『of』+『名』》
〈帆・旗などが〉『はためく』 / 『羽ばたく』 / 〈翼など〉‘を'羽ばたかせる,パタパタ(ハタハタ)と動かす / (平たくしなやかなもので)…‘を'ぴしゃりと打つ / ピシャりとたたくこと / (片方だけ留めて)垂れ下がった薄いもの;(特に)(ポケットの)垂れぶた,(封筒の)折り返し / (飛行機の)下げ翼 / 《話》興奮状態

Wikipedia preview

出典(authority):フリー百科事典『ウィキペディア（Wikipedia）』「2017/06/02 10:20:34」(JST)

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The terms free flap, free autologous tissue transfer and microvascular free tissue transfer are synonymous terms used to describe the "transplantation" of tissue from one site of the body to another, in order to reconstruct an existing defect. "Free" implies that the tissue is completely detached from its blood supply at the original location ("donor site") and then transferred to another location ("recipient site") and the circulation in the tissue re-established by anastomosis of artery(s) and vein(s). This is in contrast to a "pedicled" flap in which the tissue is left partly attached to the donor site ("pedicle") and simply transposed to a new location; keeping the "pedicle" intact as a conduit to supply the tissue with blood.

Various types of tissue may be transferred as a "free flap" including skin and fat, muscle, nerve, bone, cartilage (or any combination of these), lymph nodes and intestinal segments. An example of "free flap" could be a "free toe transfer" in which the great toe or the second toe is transferred to the hand to reconstruct a thumb.

For all "free flaps", the blood supply is reconstituted using microsurgical techniques to reconnect the artery (brings blood into the flap) and vein (allows blood to flow out of the flap).

Free autologous tissue transfer is performed by many surgical specialties.

Indications

Free flaps are used to reconstruct tissue defects. Particularly when postoperative radiotherapy is indicated, vascularized free tissue is preferred over non-vascularized free tissue.

Breast reconstruction:

Aesthetic (cosmetic) reconstruction: Most commonly creating a breast after a mastectomy. This may happen at the time of mastectomy or at a later date. Free flaps are usually only done if a TRAM flap is not possible. Plastic surgeons usually perform these surgeries. Patients with Bell's palsy can have their face re-animated using "free functioning muscle flaps".

Hand reconstruction:

Reconstruction of paralyzed face or hand using functioning free muscle flaps.

Head and Neck reconstruction:

When reconstructing complex head and neck defects, the reconstruction often requires bone and soft tissue from a distant donor site to be harvested. Functional reconstruction in the head and neck area often requires reconstruction of the oral cavity, the jawbone and the dental occlusion. Type of defects include:

Reconstruction of post-traumatic defects: Some areas of the body has missing tissue either from a trauma or from some existing wound. This may include areas on the leg where bone is exposed or any other area on the body that needs soft tissue coverage.
Reconstruction of a defect following removal of a tumor in the mouth or elsewhere: Soft tissue resection requires soft tissue reconstruction. Composite (soft tissue and hard tissue) resection requires composite reconstruction. Soft tissue flaps include the radial forearm free flap and the ALT (anterolateral thigh) free flap amongst others. Composite free flaps include the fibular free flap, the DCIA free flap, the scapular free flap and the composite radial free flap amongst others. When the cancer resection involves a part of the lower jaw, depending on the patients age and the patients co-morbidities one composite free flap will be preferred over the others for reconstruction of the defect.
Reconstruction of esophageal (food-pipe) continuity using segments of intestine

Surgical Steps during "free autologous tissue transfer"

A defect is created surgically (either following removal of a tumor or following cleansing of a wound)
An incision is made over the area from where the flap will be taken.
The flap is dissected and freed from the surrounding tissue.
At least one vein and one artery (which constitutes the vascular pedicle) are dissected.
The vein and artery (vascular pedicle) are divided, separating the flap from the rest of the body.
Before the pedicle is divided, the area the flap will be re-attached to is prepared by identifying a recipient artery and vein.
The free flap is brought up to the defect area, and the vein and artery from the flap (vascular pedicle) are anastomosed (re-connected) to the vein and artery identified in the wound. The anastomosis is done using a microscope or a "loupe", hence it is termed "microsurgery"
The free flap is sutured to the defect, while it is monitored to ensure the blood vessels remain patent (i.e. the vessels have good blood flow).
The donor site area is closed primarily. Sometimes a Split Thickness Skin graft (STSG) may be performed and placed on top of the defect site and/or the donor site.

Postoperative Complications/Sequalae

The most common serious complication of a free flap is loss of the venous outflow (e.g. a clot forms in the vein that drains the blood from the flap). Loss of arterial supply is serious too and both will cause necrosis (death) of the flap. Close monitoring of the flap both by nurses and by the surgeon is mandatory following the completion of the operation.^[1]^[2] If detected early, loss of either the venous or arterial blood supply may be corrected by operative intervention. Many times an implantable Doppler probe or other devices can be installed during surgery to provide better monitoring in the post-operative period. The Doppler probe can be removed before discharge from the hospital.

Usually the harvest of a "free flap" is performed in such a fashion to cause the least amount of disability. Despite this some disability may occur following removal of this tissue from the "donor site".

Other complications/sequalae which may occur with any surgery are also possible, including infection and pain.

Bibliography

Dolan, Robert (2003). Facial, Plastic, Reconstructive, and Trauma Surgery. Informa Healthcare. ISBN 0-8247-4595-7.
Ip, David (2008). Orthopedic Traumatology - A Resident's Guide. Springer. ISBN 3-540-75860-7.
Myers, Eugene N.; Michael R. Smith; Jeffrey Myers; Ehab Hanna (2003). Cancer of the Head and Neck. Saunders. ISBN 0-7216-9480-2.
Baker, Shan R. (2007). Local Flaps in Facial Reconstruction:. Mosby. ISBN 0-323-03684-8.
Wolff, K.-D.; Hölzle, R. (2005). Raising of Microvascular Flaps: A Systematic Approach. Springer. ISBN 3-540-21849-1.

References

^ F. Hölzle, D. Löffelbein, D. Nolte, K.-D. Wolff: Free flap monitoring using simultaneous non-invasive laser Doppler flowmetry and tissue spectrophotometry. J Craniomaxillofac Surg. (2006) 34: 25-33.
^ F. Hölzle, A. Rau, D. J. Loeffelbein, M. R. Kesting, T. Mücke, K.-D. Wolff: Results of monitoring fasciocutaneous, myocutaneous, osteocutaneous and perforator flaps: 4-year experience with 166 cases. Int J Oral Maxillofac Surg. (2010) 37: 21-28.

UpToDate Contents

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1. 軟部組織再建術に用いるフラップの概要 overview of flaps for soft tissue reconstruction
2. 自家組織を用いる乳房再建術の選択肢 options for flap based breast reconstruction
3. 乳房再建の概要 overview of breast reconstruction
4. 頭頸部癌患者における下顎および口蓋再建 mandibular and palatal reconstruction in patients with head and neck cancer
5. 熱傷再建の原則：四肢および所属リンパ節領域 principles of burn reconstruction extremities and regional nodal basins

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