Novel free flap rescue

A free flap or free cap is a rare but bothersome complication seen in LASIK procedures. In conventional microkeratomeassisted flap creation, free flaps are more likely to occur with flat corneas. In contrast, in femtosecond LASIK, free flaps can occur while the flap is being handled at any point in the surgery; ie, during flap lifting, repositioning or refloating. Proper management of a free flap includes realignment and attachment. Traditional methods of securing the free flap include repositioning and air drying, pressure patching, a bandage contact lens and suturing. US researchers now describe the successful use of a single loose anchoring suture to secure a femtosecond laser-created free flap. In an otherwise normal LASIK procedure they report that a free flap occurred as the flap was being pushed down the irrigation cannula. The surgeon repositioned the free flap and placed a single 10-0 nylon suture at the 9 o'clock position with an air knot to keep the suture loose with minimal vector force on the flap and the corneal bed. The suture position allowed an adequate manoeuvring field while staying as far from the visual axis as possible. A bandage contact lens was placed over the sutured free flap. One day post-op the free flap was clear and well centred, and the suture was removed. The uncorrected distance visual acuity was 20/40 in the eye with the free flap. The flap remained clear and centred at the three-month mark, with CDVA of 20/20 and a refraction of -2.50 sphere. The procedure is simple and safe while offering the advantages of stability and minimal invasiveness. A video is available at www. jcrsjournal.org

CJ Choi et al., JCRS, “Loose anchoring suture to secure a free flap after laser in situ keratomileusisâ€, Volume 38, Issue 7, 1127-1129.