出典(authority):フリー百科事典『ウィキペディア（Wikipedia）』「2015/08/13 00:56:27」(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, along with its blood supply, is completely detached from 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 flaps may be done for a number of reasons, including:
- Reconstruction of post-traumatic defects: Some area 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: Some Head and Neck, Otolaryngologists, and Oral and Maxillofacial surgeons will excise a tumor from the head and neck leaving a large tissue defect, and then use one of a variety of techniques to reconstruct the wound--often free flaps are needed. If the cancer involves a part of the lower jaw (mandible) then often the fibula will be transplanted as a free flap for reconstruction of the jaw (replacement of the removed mandible)--although other options including bone grafts exist.
- Reconstruction of esophageal (food-pipe) continuity using segments of intestine
- Reconstruction of paralyzed face or hand using functioning free muscle flaps
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. 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.
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| リンク元 | 「皮弁」 |
| 関連記事 | 「FLAP」「flap」「skin」 |