FLAPS

FLAPS

• Flap is a piece of tissue (skin or subcutaneous fat) transferred from donor to recipient area along with its vascularity.
• Parts of flap-

1. Base
2. Pedicle
3. Tip

Indications-

• To cover defects forward where free skin graft cannot be used as exposed base bone, bare tendons, base cartilage.
• Wounds with exposed joints, exposed major vessels & nerves.
• Implant exposure
• In wounds with soft tissue loss
• Breast restruction following mastectomy.
• Skin flap is used in bone, tendon and cartilage.

Classification of Flaps-

According to proximity of the wound-

a) Local flap-

• Shares a side with the wound.
• For small defects

 

b) Distant flaps-

• Away from defects when tissue cannot cover the defect & a flap is required.
• E.g.- Forehead, deltopectoral, groin, Latissimus dorsi muscle flap (breast reconstruction), Pectoralis major flap (mandibular reconstruction), transverse rectus abdominis flap- TRAM (breast reconstruction).

 

c) Free flap-

• Tissue transferred to another site.

 

According to method of transfer (geometric design)

i) Transposition- reconstruction of facial skin defect

a) Z plasty- for pilonidal sinus, lengthening scars

 

b) Rotational flap- for gluteal region, scalp, buttocks, deltoid area

 

c) Rhomboidal flap- cheek, temporal, back & flat surface defects

 

Advancement flaps-

a) V-Y advancement flap- E.g.- finger tips, extremities

 

b) Y- V advancement

 

c) Bipedicle advancement flaps- E.g. Lower eyelid

 

According to blood supply-

a) Random pattern flap-

• For small, full thickness defects.
• Based on dermal & sub dermal plexus
• Length to breadth- 1.5:1 (limited)

E.g. Cross finger flap

 

 b) Axial pattern flap-

• Based on direct cutaneous vessels
• Longer flaps with known vessels supplying
• Develops as island flaps as flap mobility

E.g. Deltopectoral flap, groin flap

 

 c) Myocutaneous flap-

• Muscle along with overlying skin
• Useful in covering bare bone.

E.g. Pectoralis major flap

d) Fasciocutaneous flap-

• Consists of deep fascia along with overlying skin

E.g. Forehead flap, deltopectoral flap

 

According to composition of tissue-

i) Simple flaps- consist of single tissue

1. Cutaneous flaps- skin- skin flaps
2. Fascia flaps- only fascia
3. Muscle flaps- only muscle

ii) Composite flaps– more than one type of tissue

1. Musculocutaneous
2. Osteocutaneous
3. Fasciocutaneous