When a free flap is utilized, it should be regularly monitored to ensure vascular integrity. Physical examination, assessing the flap color, turgidity, and capillary refill should be routine for at least the first 48 hours postoperatively. Hand-held Doppler probes can be used to assess blood flow. In case of doubt of the vitality of the flap, pin-prick assessment with a 25 gauge needle to look for bright red bleeding. In cases of buried flaps, an implantable Doppler placed just distal to the venous anastomosis can be utilized.
Radial forearm free flap
The radial forearm free flap donor site should be closed with a skin graft and a bolster placed over the area. The arm is then cast or placed in a volar splint for 7 days prior to removal to ensure graft take. If bone is taken and the radius plated, appropriate follow-up with an orthopedic or hand specialist should be arranged.
Rectus abdominous and iliac crest
Rectus abdominous and iliac crest donor sites require that the patient not strain or lift heavy objects for at least 4 weeks to avoid hernia formation.
Patients should avoid climbing stairs for 2-4 weeks after surgery. They should also be observed for seroma formation at the wound bed.
Furthermore, patients often need physical therapy to rehabilitate the donor site.
There are no special issues for this flap except the suction drains should be left in place for 5-7 days as there is a 40 % risk of seroma formation. If a seroma does occur it can be aspirated with a large gauge needle as necessary.