Reconstructive Microsurgery in Jaipur

What reconstructive microsurgery is and how it works

Reconstructive microsurgery is a specialised operation that moves tissue from one part of your body to another to repair a complex wound or defect. The surgeon uses an operating microscope to join tiny blood vessels and nerves, usually smaller than two millimetres, so the transferred tissue survives in its new location.

This is called a free flap transfer because the tissue is completely separated from its original blood supply and reconnected at the recipient site. The tissue can include skin, fat, muscle, bone or a combination, depending on what the defect needs.

Common donor sites are:

• Forearm
• Thigh
• Lower leg
• Back or abdomen

The choice depends on the type and amount of tissue required, the blood vessel anatomy, and your overall health.

A free flap is different from a skin graft. A graft has no blood supply of its own and relies on the wound bed to grow new vessels. A flap brings its own artery and vein, which the surgeon stitches to vessels near the defect under the microscope.

This makes flaps suitable for larger defects, areas with poor blood supply, or places that need bulk and structural support such as the jaw or tongue.

The operation typically takes four to twelve hours or more under general anaesthesia. Your surgical team plans the donor site and the recipient site together, often using imaging to check the blood vessels before surgery.

Symptoms and warning signs that need urgent care

Reconstructive microsurgery is not a treatment for a symptom you notice at home; it is a planned operation after cancer removal, major trauma, or when a chronic wound will not heal. However, after the surgery you must watch for signs that the flap is in trouble.

A change in the flap colour to pale or dusky purple, a drop in temperature, swelling that increases quickly, or bleeding from the edges can mean the blood vessels have clotted or the flap is congested.

These are emergencies that need the surgical team to re-explore the flap immediately, usually within the first five to seven days while you are still in hospital.

If you are at home after discharge and notice sudden swelling, redness spreading from the wound, fever, or the flap feels cold, contact the hospital at once. Early return to the operating theatre can save the flap.

Causes and who is at higher risk for needing reconstructive microsurgery

The most common reason for free flap reconstruction is removal of a head and neck cancer.

This includes cancers of the:

• Oral cavity (lip, tongue, gum, floor of mouth, hard palate)
• Oropharynx (soft palate, tonsils, base of tongue)
• Larynx (voice box)
• Nasal cavity and paranasal sinuses
• Salivary glands
• Advanced skin cancers of the head and neck

Other causes are severe trauma that destroys skin, muscle and bone; chronic wounds that fail to heal after radiation, infection or previous surgery; and benign tumours that are large or invade nearby structures and need wide excision.

Not everyone is a candidate for free flap surgery. You need a reasonably healthy blood vessel system for the microsurgical connections to work. Uncontrolled diabetes, significant heart or lung disease, and severe peripheral vascular disease increase the risk of flap failure.

Your surgical team will assess your overall health, smoking status, and the condition of the potential donor and recipient vessels before recommending this operation.

How the need for reconstructive microsurgery is diagnosed

The decision for free flap reconstruction is made by a multidisciplinary team after the primary disease is diagnosed and staged.

For cancer, this involves:

• A biopsy to confirm the tumour type
• Imaging such as CT, MRI or PET-CT to define the extent of the tumour and whether it involves bone or deep structures
• Examination under anaesthesia to assess the exact margins

For trauma or chronic wounds, the diagnosis is based on clinical examination of the defect size, depth, exposed structures (bone, tendon, nerve, vessel), and the quality of the surrounding tissue. The surgeon checks whether a simpler option like a local flap, regional pedicled flap, or skin graft can close the defect.

If the defect is too large, involves composite tissue loss, or the local tissue is damaged by radiation or scarring, a free flap becomes the preferred option.

Preoperative imaging of the donor site vessels (CT angiography or Doppler ultrasound) may be done to confirm anatomy and rule out vascular disease, especially if you have diabetes or a history of smoking.

Non-surgical options and when reconstructive microsurgery is advised

Before recommending free flap surgery, the team considers simpler methods. A skin graft may be enough for a shallow wound with a healthy bed. A local flap uses tissue next to the defect and keeps its original blood supply; it is useful for smaller defects.

A regional pedicled flap rotates tissue from a nearby area (for example, chest muscle to the neck) on its intact blood vessel pedicle; it avoids microsurgery but has limited reach and bulk.

Free flap reconstruction is advised when the defect is large, involves multiple tissue types (skin, muscle, bone), the recipient bed has poor blood supply from radiation or scarring, or when function such as speech, swallowing, or jaw continuity must be restored. It is also used for lymphaticovenous anastomosis (supermicrosurgery) to treat lymphoedema when conservative therapy has failed.

Your surgeon will explain the options that fit your specific defect, health status, and goals. The final plan is made jointly with you and your attendants after discussing the operation time, hospital stay of seven to fourteen nights, flap monitoring for five to seven days, and a rehabilitation period of three to six months.

The typical cost range in India is ₹2,00,000 to ₹8,00,000 or more, varying with the flap type, complexity, and any additional procedures.

Preparing for reconstructive microsurgery

Before your operation, your surgical team will assess your overall health and the specific defect that needs reconstruction. This assessment helps the team choose the most suitable donor site for the free flap, which may be the forearm, thigh, leg, or back depending on the type and amount of tissue required.

You may need imaging tests such as a CT angiogram or Doppler ultrasound to check the blood vessels at the donor site and the recipient area, ensuring a reliable blood supply for the transplant.

You will meet the anaesthesia team for a pre-anaesthesia check-up.

Tell them about every medicine you take, including:

• Blood thinners
• Diabetes tablets
• Insulin
• Herbal products
• Any supplements

Your surgeon and anaesthetist will advise which medicines to continue, pause, or adjust before surgery. If you have diabetes, heart disease, or a lung condition, good control of these problems before the operation lowers the chance of complications.

You will be asked to fast for at least six hours before general anaesthesia — no solid food, and usually clear fluids are allowed up to two hours before. The hospital will confirm the exact fasting time the day before surgery.

Pack a small bag for a stay of one to two weeks. Bring comfortable loose clothing that opens at the front, your regular medicines in their original strips, any imaging films or reports, your insurance or scheme cards (RGHS, MAA Yojana, CGHS, or private TPA details), and a phone charger. An attendant should plan to stay with you during the admission.

How reconstructive microsurgery is done

Reconstructive microsurgery uses an operating microscope to join very small blood vessels and nerves.

The main techniques available at Jaipur Hospital include:

• Free tissue transfer (free flaps) such as ALT, latissimus dorsi, fibula, and DIEP flaps for composite defects
• Digital or limb replantation with arterial, venous, and nerve repair under the microscope
• Lymphaticovenous anastomosis (LVA) for lymphoedema
• Perforator flap harvest for muscle-sparing reconstruction

Your surgeon will advise which technique suits your defect, the tissue needed, and your anatomy.

On the day of surgery, you are taken to the modular operation theatre and given general anaesthesia. The procedure typically lasts four to twelve hours or more, depending on the complexity.

The main steps are:

• Tumour or damaged tissue removal: The surgeon removes the cancer, injured tissue, or non-healing wound while preserving as much healthy structure as possible.
• Flap harvest: The chosen donor tissue — skin, fat, muscle, bone, or a combination — is carefully dissected with its tiny blood vessels (artery and vein) and sometimes a nerve.
• Recipient site preparation: The area that will receive the flap is cleaned and healthy blood vessels are identified in the neck or face for connection.
• Microvascular anastomosis: Under the microscope, the surgeon stitches the flap's artery and vein to the recipient vessels. This step, called anastomosis, restores blood flow to the transplanted tissue.
• Flap inset and fixation: Once blood flow is confirmed, the flap is shaped and sutured into place. If bone is transferred (for example, fibula for jaw reconstruction), small plates and screws may secure it.
• Donor site closure: The area where the flap was taken is closed directly or covered with a skin graft if needed.

After the operation, you are moved to the intensive care unit or a high-dependency ward for continuous flap monitoring.

Risks and possible complications of reconstructive microsurgery

Free flap surgery is a major operation. While most flaps survive, complications can occur. In studies of free flap reconstruction, operative-site infection was reported in about 4.7 percent of cases. Lymphorrhea (leak of lymphatic fluid) occurred in about 7.7 percent of cases.

Re-exploration of the operation site for flap congestion — a blockage in the vein draining the flap — was needed in about 2.7 percent of cases. Additional procedures of any kind were required in about 22.6 percent of patients during the same admission.

Flap failure — complete loss of the transplanted tissue — is relatively rare but when it happens it is very morbid and psychologically devastating. Complications after free tissue transfer to the head and neck remain common.

Other risks include:

• Blockage or clots in the newly joined vessels
• Infection
• Wound healing problems at the flap or donor site

General anaesthesia carries its own risks such as heart or lung events, deep vein thrombosis, and reactions to medicines. Patients with uncontrolled diabetes, significant heart disease, or severe respiratory problems have a higher chance of complications and may not be suitable candidates for flap surgery.

Your surgical team will discuss the risks that apply to your specific operation and health status before you sign the consent form.

Recovery and aftercare after reconstructive microsurgery

After surgery you will stay in the hospital for flap monitoring, usually five to seven days, and the total hospital stay is typically seven to fourteen nights. In the first few days, nurses check the flap's colour, temperature, capillary refill, and Doppler signal every hour or two. You may have drains, bandages, or a splint to protect the reconstruction.

A temporary tracheostomy (breathing tube in the neck) is common if the reconstruction involves the tongue, throat, or jaw. It is usually removed once swelling settles and you can breathe safely. The stoma heals within a few days to weeks.

Many patients need a feeding tube — either a nasogastric tube through the nose for short-term use, or a gastrostomy tube through the abdomen if longer support is expected. The team will assess your swallowing and help you transition back to eating when it is safe.

Pain is managed with regular medication. Swelling and bruising are normal and improve over weeks. You may have temporary numbness or tightness at both the surgical site and the donor site.

Before discharge, the team will give you instructions on wound care, drain care if a drain goes home with you, medicines, and follow-up dates. You will need an attendant to help at home for the first one to two weeks.

In the first weeks at home:

• Keep the flap and donor site clean and dry as instructed.
• Avoid pressure, stretching, or trauma to the reconstructed area.
• Attend all follow-up appointments for wound checks and flap assessment.
• Start gentle movement as advised; if the flap came from your arm, leg, or thigh, you may need physiotherapy to regain strength and mobility.
• If the surgery affects speech or swallowing, a speech therapist will guide exercises.

Complete healing can take several months. Most people regain function and appearance, but some may need additional procedures such as dental implants if the jaw was reconstructed.

Call the hospital or visit the emergency department if you notice:

• Sudden colour change of the flap (pale, dusky, or very dark)
• Loss of warmth
• Rapid swelling
• Bleeding that soaks the dressing
• Fever above 38°C
• Increasing pain not relieved by prescribed medicines
• Any new breathing or swallowing difficulty

Results of reconstructive microsurgery

Free flap reconstruction is an indispensable option for complex defects of the head and neck, limbs, and other areas. In studies, these reconstructions provide excellent long-term results and help patients regain function, appearance, and quality of life after cancer surgery or trauma.

Functional recovery depends on the site and extent of resection. For patients with reconstruction limited to the oral tongue or base of tongue, significant decline in speech and swallowing is common in the early postoperative phase, but the majority recover close to preoperative level after one year.

When both the oral tongue and base of tongue are resected, speech and swallowing outcomes are poorer regardless of the flap type used. Overall results are influenced by tumour size, area of resection, method of reconstruction, and whether adjuvant radiotherapy or chemotherapy is given.

Specific flap types have recognised advantages:

• The radial forearm free flap is thin and pliable, making it suitable for restoring speech and swallowing after smaller cancers
• The fibula free flap provides bone strong enough to support dental implants, helping restore chewing ability
• The ALT and latissimus dorsi flaps can supply large amounts of soft tissue for extensive defects

For lymphoedema, supermicrosurgical lymphaticovenous anastomosis has shown reduction in excess limb circumference by about 49 percent and excess volume by about 57 percent in reported series. About 91 percent of patients reported subjective improvement, and approximately 65 percent were able to stop using compression garments at follow-up. However, about 12 percent of patients had no measurable improvement.

Advances in microsurgical technique and perioperative care continue to improve functional and aesthetic outcomes. Your surgeon will discuss the expected functional goals for your particular case.

Cost and insurance for reconstructive microsurgery in Jaipur

The typical cost range for reconstructive microsurgery in India is ₹2,00,000 to ₹8,00,000 or more. The final amount depends on the complexity of the defect, the type of flap used, whether bone or multiple tissue components are transferred, the duration of the operation, the length of ICU and ward stay, and any additional procedures or complications that arise.

Jaipur Hospital is a NABH-accredited multispecialty hospital established in 1991.

The hospital accepts patients under:

• RGHS
• MAA Yojana
• CGHS
• A panel of private insurers and TPAs

If you are covered under any of these schemes, bring your scheme card and any pre-authorisation documents at admission. The hospital's insurance coordination team can assist with the paperwork required by your scheme or insurer.

For patients paying out of pocket, the hospital will provide an estimate after the surgical plan is finalised. The estimate covers the operation, anaesthesia, implants if needed, ICU and ward stay, medicines, investigations, and standard nursing care. Items not included are typically special drugs, additional procedures, or extended stay beyond the planned period.

Discuss the estimate with the admission office before surgery so you understand what is covered and what may be extra.