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Flap Surgery In Mumbai

Advanced Tissue Reconstruction for Complex Defects After Trauma, Cancer Surgery, and Radiation at Shree Hospitals

Flap surgery is an advanced reconstructive procedure in which a block of living tissue - including skin, fat, muscle, fascia, or bone - is transferred from a donor site to a recipient site while maintaining its own blood supply. Unlike a skin graft, a flap carries its own vasculature, making it the technique of choice for reconstructing deep, complex, or poorly vascularised defects. At Shree Hospitals, our specialist plastic and reconstructive surgeons perform the full range of local, regional, and free flap procedures to restore form and function after trauma, cancer surgery, radiation injury, and congenital defects.

What is Flap Surgery?

A surgical flap is a unit of tissue that is moved from one location (the donor site) to another (the recipient site) while retaining its own blood supply through a pedicle (a vascular leash) or through microsurgical anastomosis (connection of the donor vessels to recipient vessels at the new site). This is the fundamental distinction between a flap and a skin graft - a graft is avascular when transferred and must derive its blood supply from the recipient bed, making it unsuitable for poorly vascularised, deep, or complex wounds. A flap, by contrast, brings its own circulation and can reliably survive even in compromised recipient sites, including irradiated tissue, exposed bone, exposed tendon, and infected wounds.

Flap surgery encompasses a wide spectrum of procedures. Local flaps (rotation, advancement, transposition, rhomboid) rearrange adjacent skin and subcutaneous tissue to close nearby defects. Regional pedicled flaps (such as the pectoralis major flap, latissimus dorsi flap, or gastrocnemius flap) transfer larger blocks of muscle or musculocutaneous tissue on their dominant pedicle vessels to reconstruct defects in the head and neck, chest wall, or lower extremity. Free flaps (such as the DIEP flap, ALT flap, fibula free flap, and radial forearm free flap) involve complete division of the donor vessels, transfer of the tissue to the recipient site, and microsurgical anastomosis to reconnect the circulation using vessels at the recipient site.

At Shree Hospitals, our plastic and reconstructive surgery team performs the complete spectrum of flap reconstruction including perforator flaps (DIEP, TRAM, ALT, SGAP), free bone flaps (fibula free flap for jaw reconstruction), muscle flaps for chest wall and perineal reconstruction, and fasciocutaneous flaps for limb reconstruction. All free flap cases are supported by our microsurgery team with dedicated post-operative flap monitoring using clinical assessment and Doppler monitoring of the flap pedicle for the first 72 hours to enable early identification and re-exploration of any vascular compromise.

Who Is a Candidate for Flap Surgery?

Flap surgery is indicated for:

• Post-cancer resection defects (oral cavity, tongue, jaw, breast, chest wall, perineum, scalp) where the wound cannot be closed primarily or with a graft
• Radiation-damaged tissue where skin grafts will not take due to poor vascularity from radiation fibrosis
• Exposed bone, tendon, or implant requiring vascularised soft tissue cover
• Traumatic degloving or crush injuries with complex tissue loss involving multiple tissue layers
• Pressure sore reconstruction (ischial, sacral, trochanteric) in high-risk patients
• Osteomyelitis requiring both bone debridement and vascularised soft tissue cover
• Breast reconstruction after mastectomy (DIEP flap, LD flap, TRAM flap)

 Is Flap Surgery Right for You?

A flap reconstruction is appropriate when:

• The defect involves exposed bone, tendon, joint, or implant, or is in an irradiated field where a graft would fail
• Adequate donor tissue is available at a local, regional, or distant site appropriate to the required flap type
• CT angiography or Doppler assessment has confirmed suitable perforator vessels for the planned free or perforator flap
• The patient is medically fit for a prolonged general anaesthetic (typically 4 to 10 hours for major free flap procedures)
• The oncology team has confirmed clear margins and no immediate contraindication to reconstruction
• The patient has been counselled about the donor site scar, the recovery period, and the risk of partial or complete flap failure

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Our Approach to Flap Surgery

At Shree Hospitals, every flap reconstruction is individually planned with detailed imaging, multidisciplinary team input, and a primary and backup flap strategy. We prioritise the patient's functional recovery and cosmetic outcome equally, selecting the optimal flap type for each unique defect.

Multidisciplinary Pre-Operative Planning

Every major flap reconstruction at Shree Hospitals is planned in a multidisciplinary team meeting involving the referring surgical team (oncology, orthopaedics, or trauma surgery), the plastic surgeon, and the anaesthetic team. Pre-operative CT angiography with perforator mapping is performed for all planned free perforator flaps (DIEP, ALT, SGAP) to identify and locate dominant perforating vessels and plan the flap harvest precisely. MRI is used to assess the defect volume and tissue requirements. 

Expert Flap Harvest and Inset

Our reconstructive surgeons are experienced in the full range of flap harvest techniques including intramuscular perforator dissection for muscle-sparing free flaps (DIEP vs TRAM), fibula osteotomy planning for jaw reconstruction, and perforator-to-perforator ALT flap harvest. The flap is harvested with meticulous attention to the perforator anatomy, protecting the dominant blood supply throughout. 

Dedicated Free Flap Monitoring

After free flap reconstruction, the flap is monitored continuously for the first 72 hours - the critical period for detecting vascular compromise. Our team uses hourly clinical monitoring (colour, capillary refill, turgor, temperature) combined with implantable or external Doppler monitoring of the anastomosis. Any sign of arterial or venous compromise triggers immediate return to the operating theatre for flap re-exploration.

Top Plastic and Reconstructive Surgeons in Mumbai 

Every specialist at Shree Hospitals is board-certified and has an average of 15+ years of clinical experience in flap surgery, free flap microsurgery, oncological reconstruction, breast reconstruction, and limb salvage surgery.

Plastic and Reconstructive Surgery Services At Shree Hospitals

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