Managing the outer limits of reconstruction with microsurgical free tissue transfer.

Six patients had major deficits reconstructed with microsurgical free tissue transfer. In contrast to some opinions that free tissue transfer is a "method of last resort," these patients were selected for microsurgical reconstruction as a method of first choice due to the qualities desired in the reconstruction, the reliability of the technique, and the desire to minimize the functional or aesthetic deficit at the donor site. Microsurgical techniques allowed a reconstruction in these cases that would have been difficult or impossible by conventional techniques, while they markedly improved the quality and reliability of the reconstruction and decreased the donor morbidity. Microsurgical free tissue transfer has been reported to have a success rate of 94% in centers where a significant volume of surgery is done. We believe the continued refinement of microsurgical techniques and their increased application will improve the results of reconstruction in a large category of severe traumatic and cancer defects.