Types of skin flaps pdf

Below is a list of common and eponymous plastic surgery flaps with their classification and common usage. They can be used to cover exposed vital structures or for contour restoration such as in breast reconstruction. Flaps are most commonly described based on the method of transfer action on the nutrient pedicle and design table 4. Meaning, types of flaps, classification and surgical. Pdf classification of flaps and application of the concept. Skin tags tend to occur on the eyelids, neck, armpits, groin folds, and under breasts.

With subdermal plexus flaps, the vascular supply is affected by the width of the flap base. Wound management guidelines and formulary march 20. The three basic types of the medical procedure are categorised in accordance with the nature and thickness of the skin removed. Skin paddle the island of skin that forms the cutaneous part of the flap. Skin flap skin transposition reconstructive surgery. The pedicle can be divided in 3 to 6 weeks depending upon the type of flap and the condition of the patient. Components skin flaps containing purely another component than skin. Therefore, the defect location determines the positioning of the patient. Flaps may be trained by occluding the blood supply in. Distant pedicled flaps, which transfer tissue to a. A list of the different types of flaps is shown below with some explanations.

Flap survival depends on the subdermal vascular plexus from the flap base and revascularization from the recipient bed. For example, a flap from the smile line below your cheek could be used to repair a defect in your upper lip, lower nose or cheek. A skin flap is healthy skin and tissue that is partly detached and moved to cover a nearby wound. A skin tag is a small, soft, fleshcolored benign skin growth, often on a stalk skin tags are probably the single most common bump on adult skin skin tags are harmless but can be an annoying skin problem. Live surgery limberg rhomoid flap for closure of skin cancer defect. The mucosa of free jejunal flaps and free functioning muscle transfers do not withstand long ischemia times compared to pure skin flaps or bone flaps. An island advancement flap is a special type of singlepedicle advancement flap. The area where the skin flap will be taken is called the donor site.

Flaps can be classified into different types depending on the location, the type of tissue, blood supply, proximity to defect, and type of surgery. It is made up of all layers of the skin and some fatty tissue. Patient positioning in free flap surgery is an important issue that needs to be well considered preoperatively. There are certainly other types of wounds not included in the 5 categories discussed. Flaps used for plastic surgery have their own blood supply. Pdf classification of flaps and application of the. Types of flaps according to proximity of the wound. Skin flap aftercare instructions what you need to know. They range from simple advancements of skin to composites of many different types of tissue. Apr 08, 2019 other options for facial reconstruction include grafts, local flaps, and free tissue transfer.

Advancement flaps moved primarily in a straight line from the donor siteto the recipient site. Type 1 no skin loss, type 2 partial flap loss and type 3 total flap loss. This is a multidisciplinary group of professionals working across nhs highland and nhs western isles. The simplest type of advancement flap involves sliding skin to cover an adjacent defect. Examples include cutaneous flaps involving only the skin skin flaps, fascia flaps involving only the fascia, muscle flaps involving only the muscles. Flaps are of two main types, free flaps and pedicled flaps. Flaps may be of soft tissue, skin, muscle, bone, fat or fascia. Review of rhomboid flaps and their modern modifications. There are as many types of flaps as there are types of injuries which might require the use of a flap. A skin flap may contain skin and fat, or skin, fat, and muscle.

More than half of all people with diabetes experience skin related complications. However, selecting the most suitable type of soft tissue cover for a particular defect. Feb 03, 2020 a skin flap is a portion of skin that is moved from one area of the body to another. Skin grafts have been used for over a century to resurface superficial defects of many kinds. If you have suffered tissue loss over any area of your body, you may be a candidate for flap surgery. Skin graft a skin graft is a procedure performed where healthy skin is removed from one area of the body, the donor site, and transplanted to another, the recipient site. Local flaps are created by freeing a layer of tissue and then stretching the freed layer to fill a defect. Local flap this type of flap shares a side with the defect. A local flap consists of skin and subcutaneous tissue that is harvested from a site nearby a given defect while maintaining its intrinsic blood supply. Microsurgery information for surgeons, health care professionals and patients, with detailed procedure descritpions.

The historical development of skin flaps is outlined, and in particular their division into two types. A skin graft is a piece of healthy skin removed from one area of your body to repair damaged or missing skin somewhere else on your body. The fowler, faireyyoungman and gouge types of flap increase the wing area in addition to changing the camber. Linda coll ware, in hand and upper extremity rehabilitation fourth edition, 2016.

To repair defects in which local tissue is inadequate, distant flaps can be moved on long pedicles that contain blood supply. This method uses a free flap, meaning that the tissue is completely cut free from the tummy and then moved to the chest. The pedicle may be buried beneath the skin to create an island flap or leftabove the skin and formed into a tube. Download pdf local flaps in facial reconstruction, 3e pre order. Flap surgery is a technique in plastic and reconstructive surgery where any type of tissue is lifted from a donor site and moved to a recipient site with an intact blood supply. These flaps are created from tissue next to the defect. The epidermis and part of the dermis are removed from the donor site and transplanted on the damaged area. Composite flaps these are flaps with more than one type of tissue component. Jul 21, 2018 a skin flap is healthy skin and tissue that is partly detached and moved to cover a nearby wound. Sometimes an implant is used with this type of flap, but some women have enough tissue in this area to shape the breast so that an implant isnt needed. Breast reconstruction using your own tissues flap procedures. Classification of flaps and application of the concept of vascular territories 117 perforatorbased chimeric flaps are those where two or more skin islands may be designed based on ips, all.

While all four flaps are widely useful, it is imperative to not distort the anatomy or maintain skin laxity. Advancement flaps can be used to move skin and relieve tension. The areas of the body that are most commonly used as donor sites for skin grafts. A skin flap is a portion of skin that is moved from one area of the body to another. Examples of single type of tissue include skin cutaneous, fascia, muscle, bone, and visceral eg, colon, small intestine, omentum flaps. Flap techniques used in reconstructive plastic surgery. You will need to discuss with your plastic surgeon which type of flap best suits your needs. Betty a hovey director, icd10 development and training.

Skin defects created by trauma or excision of benign or malignant lesions may be repaired by numerous methods. The tram flap procedure uses tissue and muscle from the tummy. A skin flap is a graft composed of all skin elements, i. This is distinct from a graft, which does not have an intact blood supply and therefore relies on growth of new blood vessels. A composite graft is a graft containing more than one type of tissue. Types of skin flapswplasty,rhombic flap,rotation flap. Flaps come from many different locations and are used in many different ways to accomplish the desired result. The other end of the skin flap is moved to cover the wound. The defect created in making the flap is sutured shut or repaired with an additional graft as necessary. The type of flap movement required determines which of the four main types of local flaps is used. Skin and fasciocutaneous flaps such as the radial forearm flap, lateral arm flap, anterolateral thigh flap, and the deep inferior epigastric artery flap diep have broad utility. A classification of fasciacutaneous flaps according to their patterns. Bone and deep tissues are generally treated in a similar way but the type of skin incision varies between techniques.

A pedicle tram flap leaves the flap attached to its original blood supply and tunnels it under the skin to the chest. Nb the terms interpolation flap and pedicle flap can be used interchangeably. This is the least complex type of flap and includes advancement flaps, rotation flaps, and transposition flaps, in order from least to most complex. Dept of periodontics periodontal flaps presented by, shiji margaret d. The pedicle may be buried beneath the skin to create an island flap or left above the skin and formed into tube. Flaps may be composed of just one type of tissue or several different types of tissue. Assess the surrounding skin condition for fragility, swelling, discolouration or bruising.

When a soft tissue defect of the hand is not amenable to primary closure or skin grafting, local skin flaps can be a used as a reliable source of. Smallsolidblackarrowsrepresentthevectorofadvancement or rotation needed for closure of the defect. When planned and executed properly, local skin flaps allow for rapid reconstruction with a reliable and adequate blood supply and a good skin colortexture match. Krueger flaps are positioned on the leading edge of the wings and are used on many jet airliners. However, before getting to know about the different types of skin grafting, it is necessary to gather knowledge on the common types of skin. Having said this, sometimes another repair option such as skin grafting is preferable in certain situations and your surgeon will discuss this with you. It is not an exhaustive source, and should be used in conjunction with the referenced materials and any new research which may emerge in the future.

Thin splitthickness skin grafts have the best take. A skin incision is made to create a curvilinear flap contiguous with the defect. Whether intended for temporary or permanent cover, the transplanted skin does not only protect the host bed from further trauma, but also provides an important barrier to infection. The diep deep inferior epigastric perforator flap uses fat and skin from the same area as the tram flap but does not use the muscle to form the breast shape. Skin flaps dermatologic surgery wiley online library. Mohs microscopically controlled excision for difficult skin cancers cryotherapy liquid nitrogen subcision. When planned and executed properly, local flaps allow for rapid reconstruction with a reliable blood supply, minimal morbidity, and excellent cosmesis. Flap surgery types, tests, procedures and complications. Hence it is better to keep the flap perfused until the recipient site is ready for transfer. One end of the skin flap often remains attached to the donor site and to its blood supply. The advancement of two skin edges from a fusiform skin excision represents the sim. This is done to fill a defect such as a wound resulting from injury or surgery when the. Examples include musculocutaneous flaps combining muscles and skin, osteocutaneous combining bones and skin, or fasciocutaneous combining fascia and skin. Depending upon the type, it may include the fascial layer or the muscles underneath.

The nhs highland wound management guidelines and formulary have been developed by the tissue viability leadership group. It usually requires removing most if not all of the rectus abdominis 6pack muscle on that side, which means an increased risk of bulging andor hernia on one side of the abdomen. Other tissues and skin next to the cut area will be moved to cover the area from where the diseased part was cut out. The area the skin flap will be taken from is called the donor site. Impeachment trial of president donald trump day 8 abc news live coverage abc news 14,691 watching live now. Jun 18, 2019 in the 1980s, the number of different tissue types used increased significantly with the development of fasciocutaneous fascia and skin flaps which are less bulky than muscle flaps, osseous bone flaps, and osseocutaneous bone and skin flaps. Variations of flap design include rotation flap with a back cut, bilateral rotation flap, o. Skin grafts or flaps may be used to replace large areas of skin that may have been removed during the procedure. Local flaps for facial reconstruction vula university of cape town. The skin island is designed to match the defect and is incised. Free gingiva attached gingiva mucogingival junction alveolar mucosa homan zandi enamel connective tissue je cej. The rotation flap is one of the three major types of random pattern flaps that are useful for repair of wounds in areas with limited elasticity. See pictures of skin conditions that are linked to type. Many surgical options are available to a reconstructive surgeon when faced with a difficult wound.

Types of skin flapswplasty,rhombic flap,rotation flap,note. This is a pdf file of an unedited manuscript that has. Local skin flaps, such as those described in this article, were primarily refined in the. A skin flap is designed to go over the stump, where the main consideration is to maximise blood supply and healing. Flap choice and recipient arteries are determined by this. The aim of the wound management guidelines and formulary is to provide practitioners with. Flaps composed of one type of tissue include skin cutaneous, fascia, muscle, bone, and visceral eg, colon, small intestine, omentum flaps. The goal of this section is to outline the use of local skin flaps for facial. Objective the flap should offer adequate access and have an adequate blood supply the flap must be of adequate size and fully reflected the edges must lie on the sound bone. In the 1980s, the number of different tissue types used increased significantly with the development of fasciocutaneous fascia and skin flaps which are less bulky than muscle flaps, osseous bone flaps, and osseocutaneous bone and skin flaps. Physiotherapy in burns, plastics and reconstructive surgery. This type of reconstructive plastic surgery is typically used to repair defects left behind after traumatic injury or mastectomy.

Assess degree of tissue loss and skin or flap colour using the star classification system. Theyre mostly done after removal of a skin lesion from your face. Types of grafts 1 split or partial thickness graft thiersch grafts this is the most common type of graft. However, flaps used for reconstructive plastic surgery can be broken down into two main categories. Type of incision used for below knee amputation to create. Next is an unsurpassed overview of all flap types, including some never published before. Vy advancement flap create a triangularshaped flap with the base of the flap atthe cut edge of the skin where the amputation occurred. However, any decision about management should be holistic and take into account factors such as the occupational circumstances of the patient and likely period of time off work, comorbidity, likelihood of success, donor morbidity, functional outcome, and the risks of surgery and anaesthesia. Control bleeding and clean the wound according to protocol. Request pdf skin flaps open wounds, particularly around the face, often require complicated techniques for optimal closure. It is prudent to recheck the status of the recipient vessels just before division of the flap vessels. Local flaps in facial reconstruction brings you the detailed visual guidance and unmatched expertise you need to achieve the best results for the full range of facial flap procedures. Moving flaps long distances while still attached are with a long muscularpedicle that contains a dominant blood supply a myocutaneous flap.

Learning how to care for skin flaps and grafts can help them heal more quickly and reduce scarring. Pdf classification of flaps and application of the concept of. Skin biopsy punch biopsy, shave biopsy, incisional biopsy and excision biopsy electrosurgery. Flap techniques can also produce excellent results in facial reconstruction after skin. This skin does not have its own source of blood flow. Skin flaps also often heal faster than skin grafts, and usually do not require the creation of a separate wound in another location. The type your surgeon recommends will depend on the site, size and the type of wound. Another section examines the repair of specific facial features, including the nose, ear, lip, and temple. Type of incision used for below knee amputation to create a skin flap that maximises healing. The use of skin grafts with local flaps clinical gate. A skin flap may also include muscle, cartilage, and hair. Tug transverse upper gracilis flaps, which uses tissue from the inner thigh. Byarsflaps skin flap made of dorsal prepuce to resurface the ventral penis deepithelialized scrotal flap to cover the urethroplasty to prevent fistula formation.

Skin flaps and their blood vessels may be completely removed from the donor site and connected to blood vessels at the flap site. Surgical techniques in wound management in animals. More substantial defects, or those that also involve soft tissue, bone, and nerve, are usually repaired with axial pattern flaps, regional. Feb 26, 2019 please use one of the following formats to cite this article in your essay, paper or report. The lesion diseased area of skin and tissue will be removed with some surrounding normal skin. Fullcolor clinical photographs and line drawingsalong with highquality surgical video clipscapture the latest facial reconstruction practices and effective methods like reconstruction of skin defects on. Definition a periodontal flap is a section of gingiva andor mucosa surgically separated from the underlying tissues to provide visibility and access to the bone and root surface. These flaps are elevated without regard to their vascular supply. Flap surgery is a type of plastic surgery used in various procedures like dental procedures and reconstructive surgery including breast reconstruction. Learn vocabulary, terms, and more with flashcards, games, and other study tools. There are two types of skin graft, and several different types of flap. It is the aim to avoid repositioning of the patient intraoperatively in order to save operating time.