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Conclusion Our study showed that free flaps can be safely performed in healthy patients as well as in patients with risk factors, with an acceptable flap loss rate. Randomized controlled studies are needed to clarify the exact role of each risk factor in free flap surgery.Biosynthesis of zinc oxide nanoparticles has been reported using Cocos nucifera leaf (CNL) extract along with estimation of their antimicrobial potential before and after calcination using different micro-organisms. UV-visible spectra of ZnO nanoparticles showed absorp