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A first for Hornsby Hospital

Hornsby Hospital has conducted its first-ever major microsurgical soft tissue transplant.

The procedure—known as a free flap— involved tissue from a patient’s back transplanted into their thigh. 

Plastic surgeon Dr Tim Wang, who performed the operation, said it was an exciting event at the hospital.

“This is a major milestone as it not only means Hornsby can provide state-of-the-art reconstruction care to the local community, but staff are also learning important new skills,” he said.

Free flap surgery is vastly different from a skin graft. With a free flap, a very thick piece of a patient’s own tissue is transplanted into another part of their body.

The tissue can be made up of skin, fat, muscle, and bone, and its veins and arteries are reconnected under a microscope in their new location. 

A skin graft, however, involves shaving off a very thin piece of tissue from a patient or donor. The surgeon moves the skin to a different part of the body where it picks up a new blood supply and grows.

A free flap is a reconstruction technique that has been around for decades but in the last fifteen has become the “gold standard”. It is common with breast reconstruction and traumas of the lower limb.

Tim said Hornsby Hospital has been planning to do a free flap procedure ever since it reopened its plastic surgery department in 2022. The patient, a local, was considered a good first case to take on.

He said the operation was a successful collaboration between management, nurses, and ICU.

It took a lot of work to physically get there in terms of people skills such as training nurses from the ward and ICU in how to look after and how to monitor a flap of this nature
Plastic surgeon Dr Tim Wang

Special equipment was needed for the procedure as well as coordinating theatre time. 

He said the operation is a sign of changing times at Hornsby, an area which has a growing population and a redeveloped hospital with surgeons and surgical services that need plastic surgery support. 

“Ultimately it is about being able to provide a full plastic surgery service at Hornsby Hospital — from lacerations in children, skin tears in the elderly to complex state of the art reconstruction,” he said. 

“This will complement the busy orthopaedic and general surgery services.”

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