Flaps

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-

I) 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.

II) 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

ii) Advancement flaps-

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

b) Y- V advancement

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

III) 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

IV)  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

Exam Important

I) 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.

c) Free flap-

  • Tissue transferred to another site.

II) 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

ii) Advancement flaps-

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

b) Y- V advancement

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

III) 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
Don’t Forget to Solve all the previous Year Question asked on FLAPS

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