What Is Microvascular Reconstruction?
Microvascular reconstruction, also known as free tissue transfer or free flap surgery, is a highly specialized surgical technique used to reconstruct complex defects in the head, neck, face, and body. It involves transplanting tissue — including skin, muscle, bone, or a combination — from one part of the body (the donor site) to the area that needs reconstruction (the recipient site).
What makes this technique unique is the reconnection of tiny blood vessels (arteries and veins, typically 1–3mm in diameter) using an operating microscope. This restores blood flow to the transferred tissue, allowing it to survive and heal in its new location.
Dr. Chaiyasate is one of the most experienced microvascular surgeons in the country, with over 3,500 microvascular cases and 6 American Society for Reconstructive Microsurgery (ASRM) Best Case and Best Save awards. His expertise allows him to reconstruct even the most complex defects with precision and artistry.
When Is Microvascular Reconstruction Needed?
Free tissue transfer is used when the defect is too large or complex to be repaired with local tissue alone.
Cancer Reconstruction
After removal of head and neck cancers (oral cavity, jaw, throat, skin), microvascular reconstruction restores the structures that were removed, including bone, soft tissue, and skin. This allows patients to eat, speak, and breathe normally.
Trauma Reconstruction
Severe injuries from accidents, gunshot wounds, or burns that result in significant tissue loss. Free flaps can replace missing bone, muscle, and skin to restore both form and function.
Congenital Defects
Children born with craniofacial conditions that require tissue from other parts of the body to reconstruct facial structures, such as jaw reconstruction in hemifacial microsomia.
Breast Reconstruction (DIEP Flap)
After mastectomy for breast cancer, the DIEP flap uses abdominal tissue to create a natural-feeling breast without sacrificing abdominal muscle. Dr. Chaiyasate is a recognized expert in this technique.
Osteoradionecrosis
When radiation therapy damages the jaw bone (a condition called osteoradionecrosis), microvascular bone transfer can replace the damaged bone with healthy, vascularized bone.
Complex Wound Reconstruction
Chronic wounds, infected wounds, or wounds with exposed bone or hardware that cannot heal with simpler techniques. Free flaps bring healthy, well-vascularized tissue to promote healing.
Types of Free Flaps
Dr. Chaiyasate selects the most appropriate flap type based on the defect's location, size, and the tissue components needed for reconstruction.
Fibula Free Flap
The fibula provides a long segment of strong bone that can be shaped and contoured to match the jaw. It can be combined with a skin paddle for intraoral lining. Dental implants can later be placed in the reconstructed bone.
Radial Forearm Free Flap
A thin, pliable flap ideal for reconstructing soft tissue defects in the mouth and throat. It provides excellent tissue quality for intraoral reconstruction and allows good speech and swallowing outcomes.
Scapula Free Flap
The scapula system provides multiple tissue components on a single blood vessel, allowing reconstruction of complex three-dimensional defects. It is particularly useful for combined bone and soft tissue reconstruction.
ALT (Anterolateral Thigh) Flap
A versatile flap that provides a large amount of soft tissue. It can be thinned for superficial defects or used with muscle for deeper defects. The donor site can often be closed directly.
DIEP Flap
The Deep Inferior Epigastric Perforator (DIEP) flap uses abdominal skin and fat without sacrificing the rectus abdominis muscle. This preserves core strength and provides a natural-looking, natural-feeling breast reconstruction.
Latissimus Dorsi Flap
A large, reliable flap that provides substantial muscle and skin coverage. It is useful for reconstructing large defects where significant tissue volume is needed.
The Surgical Process
Microvascular reconstruction is a complex procedure that requires meticulous planning and surgical precision.
Pre-Operative Planning
Dr. Chaiyasate uses advanced imaging (CT scans, CT angiography, MRI) to map the blood vessels and plan the surgery. 3D models and virtual surgical planning may be used for bone reconstruction to ensure precise fit and alignment.
Tumor Removal / Defect Preparation
If the surgery involves cancer, the tumor is removed first by the head and neck surgeon. The resulting defect is carefully assessed, and the reconstruction plan is confirmed.
Flap Harvest
The tissue flap is carefully raised from the donor site, preserving the blood vessels that supply it. The artery, vein, and sometimes nerve are dissected free under magnification.
Flap Inset & Shaping
The flap is transferred to the recipient site and shaped to fit the defect precisely. For bone flaps, the bone is cut and contoured using pre-planned guides to match the anatomy.
Microvascular Anastomosis
Using an operating microscope, Dr. Chaiyasate connects the tiny blood vessels of the flap to vessels in the neck or face. Sutures finer than a human hair are used to join arteries and veins that are typically 1–3mm in diameter.
Closure & Monitoring
Both the recipient and donor sites are closed. The flap is closely monitored in the ICU for the first 24–72 hours using clinical checks and sometimes an implantable Doppler device to ensure blood flow is maintained.
Recovery & What to Expect
Hospital Stay
5–10 days in the hospital, depending on the complexity of the reconstruction
First 24–72 hours in the ICU for close flap monitoring
Flap checks every 1–2 hours initially to ensure blood flow
Gradual transition to regular nursing care as the flap stabilizes
Physical therapy and occupational therapy begin during the hospital stay
After Discharge
Regular follow-up visits to monitor healing of both recipient and donor sites
Gradual return to normal diet (for head and neck reconstruction)
Speech therapy if the reconstruction involved the mouth or throat
Dental rehabilitation with implants (for jaw reconstruction) after 6–12 months
Scar maturation over 12–18 months with ongoing scar management
Most patients return to normal activities within 6–8 weeks
Dr. Chaiyasate's Expertise
With over 3,500 microvascular cases and a success rate exceeding 95%, Dr. Chaiyasate brings unparalleled experience to every reconstruction. His 6 ASRM Best Case and Best Save awards recognize his contributions to advancing the field of microsurgery. He is affiliated with Corewell Health, Trinity Oakland, and Children's Hospital at Troy, ensuring access to state-of-the-art facilities and a comprehensive support team.
Schedule a Consultation
Dr. Chaiyasate and his team are here to answer your questions and discuss the best treatment options for you or your child.