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The UCLA Division of Plastic & Reconstructive Surgery



Microvascular Surgery at UCLA in Los Angeles, California

The field of microvascular surgery is relatively new, with the first operation performed in 1973.

After 25 years of development, it now holds a critical position in the care of patients. A free flap is essentially a composite block of tissue transplanted from one part of the body to another distant site where its circulation (artery and vein) is restored utilizing microsurgical techniques.

The ability to close wounds and restore form and function utilizing transplanted tissue has forever changed the modern approach to reconstruction and continues to expand the indications for surgery.

The following free flap procedures are performed at UCLA:

  • Breast: reconstruction with the free TRAM, superior and inferior gluteal flap, TFL flap, Ruben's flap, gracilis flap
  • Trunk: coverage of the abdomen and chest, specifically following large wounds typically associated with radiation therapy and cancer resections
  • Head and neck: reconstruction of the mandible, esophagus, scalp and cranial base
  • Lower extremity: free flap coverage of traumatic wounds and post-oncologic resections, salvage of amputation stumps, bony reconstruction, coverage of nonhealing lower extremity ulcers secondary to diabetes, arterial or venous insufficiency.
  • Facial re-animation: restoration of facial expression following nerve injury / cancer resections
  • Hand: wound coverage, digital replacement and reconstruction, functioning muscle transplantation.

Free flap surgery is a complex operation that requires a high degree of surgical expertise and experience. By continued refinement of techniques and a high volume of cases, we have been able to maintain a high rate of success approaching 98% patency rates.

Given the low complication rates and high success rates, this field of surgery has shifted from that of being "experimental" and "procedures of last resort" to routine and first-choice reconstructive techniques.

Continued research in the field of flap pre-fabrication and tissue engineering will continue to expand this surgical arena.

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