Downloaded 61 times
Uploaded byDr Safika Zaman
Local flaps in ent
This document discusses various flap techniques used in ENT reconstruction. It begins with a brief history of flaps and then covers principles of mucosal, skin, bony, lip, nasal, and pinna reconstruction. Different types of flaps are described such as local advancement flaps, rotational flaps, transposition flaps, interpolated flaps, myocutaneous flaps, and examples such as forehead, nasolabial, pectoralis major, deltopectoral, and temporoparietal flaps. Design, vascular supply, and advantages of local flaps are also summarized.
More Related Content
Similar to Local flaps in ent
More from Dr Safika Zaman
Local flaps in ent
- 1. Flaps in ENT DRSAFIKA ZAMAN DEPT OF ENT & HEAD NECK SURGERY VIMS,RKMSP
- 2. Introduction Indication- Trauma Infection Osteonecrosis Tumour excision
- 3. History Forehead rhinoplastyflap nasal reconstruction- Sushruta (600–800BC) Pedicled medial arm flap- Gasparo Tagliacozzi (1546 and 1599) Porehead flap - Mc Gregr in 1963 for intraoral reconstruction. Delto-pectoral flap by Bakamjian in 1965 Pectoralis major flap in 1979 by Ariyan. Sushruta
- 4.
- 5. Mucosal Reconstruction principle Oralcavity- maintenance of tongue mobility, lingual sulcus,& mouth opening avoidance of convexities at sites of concavity. Oropharynx - prevent nasal escape and hypernasality, maintaining velopharyngeal competence.
- 6. Skin reconstruction principle Orientate scar lines in the lines of election. Reconstruction of aesthetic subunits. Replace like with like. Avoiding bulk where thinness is needed and vice versa. Avoid tension at close line. Consider fixing with underlying structure. Image- Stell & Maran text book
- 7. Aesthetic subunits offace Image- Stell & Maran text book
- 8. Principle of bonyreconstruction Two main bone - Mandible and Maxilla. Principles of reconstruction- cosmesis, speech, swallowing, chewing and dental occlusion
- 9. Bony reconstruction Decision makingin bony reconstruction – Defect Postoperative radiotherapy Radio-necrosis Donor vessels in the region Fitness Height of the native mandible Presence of teeth Availability of donor sites
- 10. Lip reconstruction Principles- Oralcompetence Labial sensation Lower sulcus Aperture size Cummings -ENT book
- 11. Nasal reconstruction Skin Skeletal support Mucosal lining
- 12. Pinna reconstruction Partialauricular reconstruction Total pinna reconstruction- multistage, costal cartilage use Autologous prosthetic.
- 13. Flap Flap isa piece of tissue with its own blood supply and its survival is not dependent upon the recipient site.
- 14. Advantage of alocal flap Reliable blood supply Good skin texture and colour match Single stage procedure
- 15. The reconstructive ladder Image-Scott Brown’s text book
- 16. Vascular supply When theperfusion pressure drops below a critical closing pressure of the arterioles in the subdermal plexus, nutritional blood flow ceases and flap ischemia occurs.
- 17. Composition of aflap Cutaneous Fascio-cutaneous Musculocutaneous Osteomusculo-cutaneous Free fibula graft
- 18. Myocutaneous flaps Pectoralismajor Temporalis Radial forearm free flap Radial forearm free flap
- 19. Method of transferand design
- 20. Advancement Flaps Slidealong a linear vector to close a defect. The flap relies on stretching of tissue for advancement. Utilized in areas of good skin elasticity. Point of greatest wound tension is at the distal border of the flap. Uni-pedicle, bi-pedicle, and V-Y flaps
- 21. Bilateral unipedicle advancementflap OPEN ACCESS ATLAS OF OTOLARYNGOLOGY, HEAD & NECK OPERATIVE SURGERY LOCAL FLAPS FOR FACIAL RECONSTRUCTION Shiayin Yang, Carl Truesdale, Jeffrey Moyer
- 22. V-Y Advancement flap OPENACCESS ATLAS OF OTOLARYNGOLOGY, HEAD & NECK OPERATIVE SURGERY LOCAL FLAPS FOR FACIAL RECONSTRUCTION Shiayin Yang, Carl Truesdale, Jeffrey Moyer
- 23. Rotational flaps Versatileflaps Flap is designed in a curvilinear fashion with the defect forming a portion of the flap’s arc of rotation The point of greatest wound tension is at the apex of the flap Image-double rotational flap
- 24. Rotation flap OPEN ACCESSATLAS OF OTOLARYNGOLOGY, HEAD & NECK OPERATIVE SURGERY LOCAL FLAPS FOR FACIAL RECONSTRUCTION Shiayin Yang, Carl Truesdale, Jeffrey Moyer
- 25. Transposition flaps Designedremotely from the primary defect. Base is contiguous with the defect Greatest wound closure tension is at the closure site of the secondary defect. Small and medium-sized defects of the cheek and nose
- 26. Note flap OPEN ACCESSATLAS OF OTOLARYNGOLOGY, HEAD & NECK OPERATIVE SURGERY LOCAL FLAPS FOR FACIAL RECONSTRUCTION Shiayin Yang, Carl Truesdale, Jeffrey Moyer
- 27. Bilobed flap Bilobe flapwith 90° axis of rota-tion. The first lobe is equal in diameter to the defect while the second lobe has a small-er diameter
- 28.
- 29.
- 30. Rhomboid flap OPEN ACCESSATLAS OF OTOLARYNGOLOGY, HEAD & NECK OPERATIVE SURGERY LOCAL FLAPS FOR FACIAL RECONSTRUCTION Shiayin Yang, Carl Truesdale, Jeffrey Moyer
- 31. Interpolated flaps Baseof the flap is not contiguous with the defect. Pedicle passes over intervening tissue to close the primary defect. Need a 2nd stage procedure.
- 32. Para-median forehead flap Nasalreconstruction for large defect supratrochlear artery and with some contributions from the supraorbital artery
- 33. Melolabial flap Melolabial flapis an interpolated flap that transfers tissue from the cheek to recon- struct nasal ala defects.
- 34. Abbe flap Labialartery based flap Labial artery runs between the orbicularis oris and lip mucosa. When lip defect > 25%.
- 35.
- 36. Glabellar flap V-Yadvancement flap. Mainly in upper nose & medial eye.
- 37. Nasolabial flap Nasal Reconstruction:An Overview and Nuances November 2008Seminars in Plastic Surgery 22(4):257-68 DOI: 10.1055/s-0028-1095885
- 38. Pectoralis major myocutaneousflap Flap comprises the pectoralis major muscle, with or without overlying skin. Pectoral branch of the thoracoacromial artery. Soft tissue defects of the oropharynx, oral cavity, hypopharynx, and skin of the neck;
- 39. Delto-pectoral flap DPflap is a pedicled axial fasciocutaneous flap. Based on the internal mammary artery perforator arteries (IMAP)
- 40. Temporoparietal flap Versatileflap Repair craniofacial defect. For scalp, auricle, facial soft tissue, orbital, oral cavity nasopharyngeal, and skull base defects.
- 41.
- 42. Hadad-bassagasteguy flap commonlocal flap used in the reconstruction of the meninges It is a nasoseptal flap (NSF) vascularized by the sphenopalatine artery
- 43. approach to facialreconstruction Concepts in local flap design and classification Krishna G. Patel, MD, PhD,a Jonathan M. Sykes, MDb From the aDepartment of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina; and the bDepartment of Otolaryngology-Head and Neck Surgery, University of California, Davis Medical Center, Sacramento, California.
- 44. THANK YOU Life-size waxmodel of the head and upper torso, constructed for teaching purposes, illustrating surgical techniques including forehead and tubed pedicle flaps. Part of the New Zealand records returned to Sidcup in 1989 and subsequently restored at Madame Tussaud’s.