Hand & Limb
Hand replantation at the wrist
The hand survived. At nine months the wrist had healed, the fingers extended and flexed actively, and the replanted hand sat level with the uninjured one.
9 months post-op
RECONSTRUCTIVE MICROSURGERY • FREE TISSUE TRANSFER
Reconstructive Microsurgery in Ahmedabad by Dr. Aniket Dave
Free flap reconstruction for cancer, major trauma and chronic wounds — vessels under 2 mm reconnected under the operating microscope to restore both form and function.
- Duration4 – 12 hours
- RecoveryVariable by site
- AnaesthesiaGeneral
- Downtime6 – 12 weeks for major reconstruction
Microsurgery
What is Reconstructive Microsurgery
The procedure, explained.
Reconstructive microsurgery is the most technically demanding discipline in plastic surgery — the rebuilding of a defect by moving living tissue from one part of the body to another and reconnecting its blood supply under the operating microscope. This is free tissue transfer, or a free flap: skin, fat, muscle or bone is detached completely from its original site, transplanted to the defect, and its artery and vein — often less than 2 mm across — are sutured to recipient vessels using thread finer than a human hair. Within minutes the tissue is alive again in its new home. It is the technique that makes the impossible routine: rebuilding a jaw after oral cancer with a section of fibula, reconstructing a breast with the patient's own abdominal tissue, covering an exposed tibia after a road accident, or filling a chronic wound eroded by osteomyelitis. Dr. Aniket Dave's core specialty is microsurgical reconstruction, and he works hand-in-hand with oncologists, trauma teams and orthopaedic surgeons across Ahmedabad. The guiding principle is never closure alone — it is the restoration of both form and function, so that a reconstructed jaw can chew, a reconstructed limb can bear weight, and a reconstructed face can be lived in without apology. Free flaps demand a surgeon comfortable at the highest acuity and a system built to monitor a flap's blood supply hour by hour in the days after surgery.
Who is a good candidate
Is this procedure right for you?
Reconstructive microsurgery is considered when a defect is too large or too complex for local tissue alone.
- Head & neck reconstruction after oral, tongue or jaw cancer resection
- Breast reconstruction using your own tissue (DIEP, free TRAM)
- Lower-limb salvage after major trauma with exposed bone or tendon
- Chronic, non-healing wounds and pressure sores with dead space
- Osteomyelitis requiring debridement and vascularised bone or muscle
- Amputated digits or limbs suitable for replantation
- Composite defects needing skin, muscle and bone together
- Failed previous reconstruction or unstable scarred wounds
Dr. Dave's approach
Reconstruction is a cancer and trauma decision, not just a surgical one.
A free flap is rarely a solo undertaking. For head & neck cancer, Dr. Dave plans the reconstruction in the same sitting as the resecting surgeon, so that the fibula or radial forearm flap is shaped to the exact defect the moment it is created. For trauma, the timing of flap cover is critical — early definitive cover protects exposed bone and lowers infection risk. The flap is chosen for the job, not for habit: a thin, pliable radial forearm for the inside of the mouth; a bulky ALT or gracilis for a deep cavity; a fibula when bone is needed. Every case is rehearsed against imaging and a clear functional goal. Surgery is performed under consultant anaesthesia with the operating microscope, and the flap is monitored intensively afterwards because the first 72 hours decide its survival.
The procedure, step by step
What happens on the day.
How a free flap reconstruction unfolds.
- 01
Planning and flap selection
Imaging, vessel mapping and a joint plan with the oncology or trauma team to match the right flap to the defect.
- 02
General anaesthesia
Administered by a consultant anaesthetist for a long, stable operation; you sleep throughout.
- 03
Defect preparation
The tumour bed or wound is cleared, debrided of dead tissue, and recipient artery and vein are identified.
- 04
Flap harvest
The flap — ALT, DIEP, fibula, gracilis or radial forearm — is raised on its feeding vessels and tailored to the defect.
- 05
Microvascular anastomosis
Under the operating microscope, the flap's vessels (often under 2 mm) are sutured to recipient vessels and blood flow is restored.
- 06
Inset and shaping
The flap is positioned, contoured and secured; bone segments are plated where a jaw or limb is being rebuilt.
- 07
Closure and flap monitoring
The donor site is closed, drains placed, and the flap is monitored hourly for colour, warmth and Doppler signal.
Recovery timeline
A realistic recovery, day by day.
Day 1 – 3
Intensive flap monitoring in a high-dependency setting. Strict positioning, warmth and hydration to protect the new blood supply.
Week 1
Drains removed as output settles. Mobilisation begins. Donor-site care and early swallowing or weight-bearing assessment by site.
Week 2 – 4
Discharge for most uncomplicated flaps. Wound healing consolidates; dressings simplify. Light daily activity resumes.
Week 6 – 12
Return to most normal activity. Function-focused rehabilitation — speech and swallow therapy, or graded limb loading — continues.
Month 3 – 12
Flap softens and settles. Secondary refinements (debulking, contouring) are planned once tissues are stable.
Before & after
Consented patient outcomes.
Published with the patient's written consent and shown unretouched. Graphic photographs stay hidden until you choose to view them.
Craniofacial
Jaw tumour resection and reconstruction
Facial symmetry was restored and the patient regained a full range of mouth opening — visible in the post-operative photographs taken nine weeks after surgery.
9 weeks post-op
Before
After
Hand & Limb
Heel reconstruction with a flap
The flap took and the heel healed with a stable, weight-bearing surface. The limb was preserved.
5 weeks post-op
Cost of reconstructive microsurgery in Ahmedabad
Transparent pricing, no surprises.
₹1,50,000—₹6,00,000
Highly variable; oncologic and trauma reconstruction is often insured.
Free flap reconstruction in Ahmedabad spans a wide range because no two reconstructions are alike — a single soft-tissue flap for a wound is a different undertaking from a fibula jaw reconstruction with plating after cancer. Theatre time, microsurgical complexity, hospital and high-dependency stay, and any bone or hardware all move the figure. Importantly, reconstruction following cancer resection or major trauma is commonly covered by health insurance, and we help patients and families navigate pre-authorisation and paperwork.
- Type of flap (soft-tissue vs bone-bearing such as fibula)
- Cancer/trauma reconstruction vs elective
- Length of theatre time and microsurgical complexity
- High-dependency and total hospital stay
- Bone plating, hardware and implants
- Insurance status and pre-authorisation
Risks & considerations
Honest pre-op disclosure.
Microsurgery is reliable in trained hands, but free tissue transfer carries real risks that Dr. Dave discusses frankly before surgery.
- Flap failure — total loss occurs in roughly 2 – 5% of free flaps despite best technique
- Partial flap loss requiring debridement or a secondary flap
- Vessel thrombosis in the early window — the reason for hourly monitoring
- Donor-site morbidity (weakness, numbness, hernia or scarring by site)
- Bleeding, infection and wound breakdown
- Anaesthesia risk over a long operation (screened pre-op)
Why patients choose Dr. Dave for this procedure
6 specific commitments for reconstructive microsurgery.
- Reconstructive microsurgery is his core specialty, not an occasional procedure
- Microsurgery fellowship training in free tissue transfer and replantation
- Routine command of ALT, DIEP, fibula, gracilis and radial forearm flaps
- Joint planning with oncology, trauma and orthopaedic teams in Ahmedabad
- Structured hourly flap-monitoring protocol through the critical first 72 hours
- Function-led rehabilitation built into the reconstructive plan
Frequently asked
Questions patients ask about reconstructive microsurgery.
A free flap is a piece of your own living tissue — skin, fat, muscle or bone — moved from one part of the body to rebuild a defect elsewhere, with its blood vessels reconnected under the microscope so the tissue stays alive in its new site.
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Begin your consultation
A private conversation about what's possible.
Forty-five minutes with Dr. Dave. A clinical examination. 3D imaging where relevant. A written plan and transparent quote. No obligation, no upsell — just an honest discussion of your options.