Principles of free tissue transfer in orthopaedic practice.

Free tissue transfer is a vital adjunct to orthopaedic practice; it may optimize the treatment of many emergency and elective conditions that require soft-tissue or bone augmentation. Consultation with a colleague trained in microsurgery is often necessary in undertaking free tissue transfer techniques. A two-team approach frequently is used to maximize efficiency and minimize fatigue. Flaps with reliable pedicle anatomy are preferred. Flaps typically are raised using an open technique, but endoscopic techniques can be utilized to decrease donor-site scarring. Free tissue transfer is a demanding procedure; careful preoperative planning is essential to ensure optimal results. Free tissue transfer inevitably results in some donor morbidity, and flaps are carefully chosen to minimize this. The most serious complication is failure of the flap. Free muscle flaps used in soft-tissue reconstruction today result in little loss of function.