Reverse Microvascular Surgery - a New Paradigm

Classically, a pedicle flap from harvesting to division & inset of flap takes 3 weeks to sometimes 4 weeks if flap delay is done before division of flap. Whereas microvascular free flap can be performed in single day. Moreover, with addition of escalator/lift concept in ladder of reconstruction, microvascular single stage flap is possible & favored. But there are reasons when even, if possible, microvascular flap is not done. In this study, author discuss these reasons/factors when single stage microvascular flap though not possible but still can be performed in two to three stages of each 2 hours duration. Further, author proposes a new paradigm of doing microvascular flap by converting single stage microvascular flap (of usual duration of approx 6 hours on an average) into multiple (two to three stages) of maximum two hours of duration. This study highlights the experience of performing one microvascular flap in three stages of each 2 hours duration for a case of post burn contracture deformity of left foot as patient refused for prolonged anesthesia required for single stage microvascular.