Flaps Dr.Ahmed Nawres
A flap, in contrast to a graft, is transferred with an intact circulation (i.e. with an arterial input & venous outflow); enable the plastic surgeon to cover defects unsuitable for skin grafting , e.g bone without periosteum,tendon without paratenon,cartilage without perichondrium.
Classification:
1st: According to tissue involved.
e.g. skin flap (fascio cutaneous flap), muscle flap, myocutaneous flap…etc.
2nd: According to their blood supply:
Could be: Random F: has no specific a.v.system, received bd supply through
The dermal – sub dermal plexus only. Limited length/width
Ratio, usually 2:1 or 1.5:1.
Axial F: has defined anatomical a.v.system.
Unlimited length/width ratio, depend on length of the vessels
Elevated.
It could be: peninsular, island, or free flap.
3rd: According to where they are moved:
A: Local Flap:
àRotate around a pivot point:
Rotation F: cut in a semicircle form.
Transposition F: cut in s rectangular or square form.
Examples of transposition flaps:
Limberg flap
Dufourmental flap
Z plasty
Bilobed flap.
Interpolation F: cut in any form and rotate around a pivot point
Into a nearby but not immediately adjacent defect
(ie, the donor site is separated from the recipient site
&the pedicle of the flap must pass over or under the
Tissue to reach the recipient area).
àAdvancement F: directly move foreword without any rotation or
Lateral movement. It could be
Single pedicle, bipedicle, V-Y advancement,
Y-V advancement flap.
B: Distant Flap:
Could be: direct flap e.g. groin flap for hand, or cross leg flap.
: Indirect flap (Jumping flap).
C: Free flap: the vascular pedicle is divided and reanastomosed with the
Recipient site vessels.
Uses of flaps
1: Closure of wound with poor vascular bed.
2: Reconstruction of facial features e.g. reconstruction of complex defects.
3: Padding over bony prominence e.g. muscle flaps are effective in filling dead space.e.g in bed sore surgery.
4: Permitting operation through the flap on underlying structures.
5: Restore sensation to anesthetic area.e.g. a sensate intercostal muscle flap for bed sore reconstruction.
6: Muscle flap is sometime effective when functioning transfer is required.e.g the use of lattisimus dorsi muscle flap to restore elbow flexion.