Plastic and reconstructive surgery aims to restore form and function through surgical techniques. The key areas covered are anatomy of skin circulation via perforators, angiosomes, and vascular territories; skin physiology and function; and the reconstructive ladder of closure techniques from primary closure to grafts and flaps. Flaps maintain an intrinsic blood supply unlike skin grafts.
Made by Ranjith R Thampi. A surgery powerpoint I made during internship for Management of Varicose Veins. Tried to cover as much as possible on the topic. Kindly comment before you download. Thanks!
Made by Ranjith R Thampi. A surgery powerpoint I made during internship for Management of Varicose Veins. Tried to cover as much as possible on the topic. Kindly comment before you download. Thanks!
Angiosome (from the Greek angeion, meaning vessel, and somite, meaning segment of the body derived from soma, body).
A three-dimensional composite unit of tissue supplied by a given source artery.
A power point on the various types of flaps and their respective indications. This presentation briefly describes the various flaps and how to care for flaps.
5. Anatomy of Circulation
• The blood reaching the skin originates from deep vessels
• These then feed interconnecting perforator vessels which
supply the vascular plexus
• Thus skin fundamentally perfused by musculocutaneous or
septocutaneous perforators
6. Anatomy of Circulation
• The vascular plexuses of the fascia, subcutaneous tissue and
skin are divided into 6 layers
7.
8. Angiosomes
• Similar to a skin dermatome is a composite block of 3
dimensional tissue supplied by a named artery
• Entire skin surface of the body is therefore perfused by a
multitude of angiosome units
• First studied by Marchot 1889, expanded by Salmon 1930 and
more recently by Ian Taylor
9. Taylor GI, Palmer JH. The vascular territories (angiosomes) of the body:
experimental study and clinical applications. Br J Plast Surg. 1987;40:113.
• 3D composite of tissue
supplied by an artery &
draining vein
• Direct perforators are more
common in the limbs,
whereas indirect
perforators predominate in
the torso
10.
11. SKIN: Physiology & Function
• Epidermis:
– protective barrier (against mechanical damage,
microbe invasion, & water loss)
– high regenerative capacity
– Producer of skin appendages (hair, nails, sweat &
sebaceous glands)
12. SKIN: Physiology & Function
• Dermis:
– mechanical strength (collagen & elastin)
– Barrier to microbe invasion
– Sensation (point, temp, pressure, proprioception)
– Thermoregulation (vasomotor activity of blood
vessels and sweat gland activity)
23. What is a Flap?
• 16th century Dutch word “flappe”
– ….something that hangs broad and loose ,
fastened only by one side..”
24. What is a Flap?
• A flap is a unit of tissue that may be transferred from a
donor to a recipient site while maintaining its blood
supply.
– Flaps can be characterized by their component parts
• cutaneous, musculocutaneous, osseocutaneous
– Their relationship to the defect
• local, regional, or distant
– Nature of the blood supply
• random versus axial
– The movement placed on the flap
• advancement, pivot, transposition, free, pedicled
26. Fasciocutaneous flaps
Cormack &Lamberty (BJPS 1984)
• Type A – multiple perforators in the flap base
– no discrete origin
– may be combination of direct or indirect
perforators
• Type B – pedicle or free flap based on a single
perforator
• Type C – multiple segmental perforators from
the same vessel
28. Reconstructive ladder
• Primary closure
• Delayed primary closure
• Secondary intention
• Graft
– Transfer of tissue with no intrinsic blood supply
• Flap
– Transfer of tissue with intact blood supply
29. Flaps
• Simple or random patterned
– based on movement (advancement,
rotation, transposition
• Complex - named anatomic blood supply
• Local vs distant
• Pedicled vs Free (microvascular)