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Types of flap
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- 2. Introduction • FLAP arevascularized block of tissues that are moved from one pace to another and carry their own vascularity with them. • Flap description • anatomical(blood supply) vs technical ( method of raising/transfering)
- 3. Flap description Technical (method of transfering) • Rotation • Transposition • Advancement • Interpolation
- 4. Rotation flap • Verylarge semicircular peace of skin adjacent to defect used to cover the defect, • May be undefined blood vessel • Different from transposition flap is usually primary defect is not left over • Eg used to cover defect in sacral bed sore
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- 6. Transposition flap • Differentfrom rotation flap is usually primary defect left over to be covered by skin graft/primarily • Eg- tensor fascia lata transposition/myocutneos/axial • Can be Z –plasty/ limberg or rhomboid flap
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- 9. Advancemet flap • LikeRectangular and V-Y advancement
- 10. Interpolation flap • Rotatedabout a pivot point and inset into defect near the donor • example thenar flap for finger tip • reconstruction
- 11. CLASSIFICATION OF FLAP CIRCULATIONPATTERN • RANDOM-do not have a specific or named blood vessel incorporated in the base of the flap. • AXIAL-specific named vascular system that enters the base and runs along its axis. TYPES free Peninsular – skin and vessel intact in pedicle Island – vessels intact, but no skin over pedicle
- 13. CONT. • PEDICLED VS.FREE • a. Pedicled flaps- The pedicle is the base that remains attached and includes the blood supply.. Usually via a musculocutaneous or fasciocutaneous fashion. • b. Free flaps-. They require re-anastamosis of the artery and vein to recipient vessels at the recipient site
- 14. CONT. • Perforator flap-consisting of skin and/or subcutaneous fat supplied by vessels that pass through or in between deep tissues It can be transferred either as a pedicled or free flap. -Deep inferior epigastric perforator flap- DIEP -Anterolateral thigh perforator flap- ALTP -Thoracodorsal artery perforator flap- TAP
- 16. Cont. • subclassifications offlap circulation by Nahai and Mathes for fasciocutaneous flaps.
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- 18. Based on Composition SINGLEAND MULTIPLE COMPONENT SINGLE-a. Skin flap- i.e. Parascapular flap b. Muscle flap- i.e. Rectus muscle flap or latissimus dorsi muscle flap c. Bone flap- i.e. Fibula flap d. Fascia flap- i.e. Serratus fascia flap MULTIPLE-a. Fasciocutaneous- Radial forearm flap or anterolateral thigh flap b. Myocutaneous- Transverse rectus abdominis myocutaneous flap c. Osseoseptocutaneous- Fibula with a skin paddle
- 19. Based on Contiguity Basedon the proximity to the primary defect that needs to be reconstructed. • Local-tissue adjacent to the primary defect • Regional -tissue in the vicinity,same anatomic regon but not directly adjacent to the primary defect. • Distant-microvascular free flap, tissue at a distance (different anatomic region) from the primary defect. THREE TYPES- DIRECT (PEDICLED) ;TUBED AND FREE FLAP
- 22. Based on Conditioning •any procedure that increases the reliability of a flap by enlarging the angiosome of the pedicle artery from its dynamic toward its potential angiosome • Chages made to flap • Types – Delay-pedicled transverse rectus abdominis myocutaneous (TRAM) flap tissue expansion prefabrication senate ( sensory nerve) functional (motor nerve)
- 23. Some special flaps Combinedflaps –The flaps in these groups are either attached by a common vascular supply or are directly attached, each with its own vascular supply Two types Conjoied and Chimeric flaps
Editor's Notes
- #5 Back cut
- #10 Islanded flap, cut on all side but base still attached margin of flap is raised and advanced along the axis of defect
- #17 Type A Direct cutaneous vessel that penetrates the fascia- Temporoparietal fascial flap Type B Septocutaneous vessel that penetrates the fascia- Radial artery forearm flap Type C Musculocutaneous vessel that penetrates the fascia- Transverse rectus abdominis myocutaneous flap
- #18 Type I One vascular pedicle Gastrocnemius ; Type II Dominant and minor pedicles (the flap cannot survive based only on the minor pedicles) Gracilis Type III Two dominant pedicles Rectus abdominis Type IV Segmental pedicles Sartorius Type V One dominant pedicle with secondary segmental pedicles (the flap can survive based only on the secondary pedicles) Pectoralis major
- #20 Local flap are rotational, transposition and advancement type , regional- interolation type Distant flap example-Eg lumber flap, fibular osteocutaneous flap , radial forearm flap, rectus abdominis flap