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Local flaps in ent
This document discusses various techniques for reconstructing skin and soft tissue defects in the head and neck region. It describes different types of grafts, local flaps, regional flaps, and free flaps that can be used including split thickness grafts, full thickness grafts, axial pattern flaps, transposition flaps, pedicled flaps like pectoralis major and latissimus dorsi flaps. Careful preoperative planning is important when using local flaps for head and neck reconstruction.
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Local flaps in ent
- 1. Dr.Ajay Manickam Junior ResidentENT & Head Neck Surgery R.G. Kar Medical College
- 2. Simple injury/ surgical Repairable ….??? Many defects can be directly closed if small & enough tissue available locally
- 3. If thedefect becomes larger...... Ablative cancer surgery
- 4. Larger defects 1.Grafts 2. Local flaps 3. Pedicled flaps 4. Free flaps 5. Combination
- 5. These areparallel to natural skin wrinkles Surgical incision placed parallely Least tension as skin contraction is at its greatest
- 6. Ellipse threetimes as long as its wide If ellipse is too short dog ear deformity
- 7. Eye lid Helical rims of ear Lips Not only skin – composite tissue - closed in layers 1. Lips – mucosa, orbicularis oris, skin 2. Ear – cartilage and skin both anterior & posterior 3. Eyelids – conjunctiva, tarsal plate, orbicularis oculi and skin
- 8. 1817 –Sir Astley Cooper 1871 – Lawson – elective full thickness graft 1872- Ollier – split skin graft 1929 – Brown & Blair – differentiated full thickness and split thickness skin grafts advantages & disadvantages
- 9. Split thickness– part of dermis Full thickness – all of dermis Composite – skin & another tissue
- 10. Graft origin 1. Autograft – same person 2. Isograft – identical twin 3. Allograft –same species 4. Xenograft – diff species 5. Alloplastic - synthetic
- 11. SPLITTHICKNESS More likelyto take Contracts more Pigment abnormal Limited sensory recovery FULLTHICKNESS High risk for graft loss Less Better colour match Better sensory recovery
- 12. Imbibition –plasma – 48 hours Inosculation - Graft revascularization – graft anastomosis Neovascularization – atleast a month
- 13. Relies onskin elasticity Modified in a number of ways – burow triangle Simple Rintalla flap Modified V-Y flap (axial flap) Bipedicled flap Tripier flap
- 14. Simple flaplesions in nasal tip
- 15. Kind ofadvancement flap modified
- 16. Lower eyelidreconstruction Bipedicled flap – receives blood supply from both ends
- 17. Moves arounda pivot point – transposition flap or rotation flap Rhomboid flaps – transposition flaps – donor defect closed directly Flag or banner flaps – transposition flaps – donor site closed directly Bilobed flaps – two transposition flaps
- 18. Pivot flap Rhomboid needs to be 120 & 60 degree So that scar becomes parallel
- 19. Pivot flap– axial transposition flap Flap lengh 3 times the length of base Primary defect closed directly
- 20. Two transpositionflaps Defects in tip of nose
- 21. Large flapsthat rotate into primary defect Flap circumference should be atleast 8 times Repairs defect of scalp or cheek
- 23. Based onnamed arterial pedicle runs within skin superficial to the underlying muscle layer parallel to the skin overlying
- 24. Forehead flap Nasolabial flap Submentalisland flap Facial artery myomucosal flap Temporo parietal fascial flap
- 25. Mc gregor Cutaneous axial median forehead flap – supra trochlear artery Cheek , External nose Forehead flap contracts excessively
- 26. Susruta 600Bc – defects around face – anterior oral cavity Based on distal branches of the facial artery Extremely reliable based inferiorly Anterior floor of mouth , gingiva – simple & effective
- 27. Reconstruction of facialskin or intra oral lining Supplied by facial artery branches Can be tunneled under mandible through submental and submandibular space for oral reconstruction / tranposed onto face for soft tissue coverage
- 28. Pribaz Oralmucosa and buccinator muscle branches of facial artery Small mucosal defects of the oral cavity, mucosa of lip, tongue, palate
- 29. Golovine Freefacial flap for reconstruction of head & neck Superficial temporal artery – external carotid artery Teardrop, elliptical shape Orbital reconstruction, auricular reconstruction, palate reconstruction, buccal mucosal reconstruction.
- 30. Deltopectoral flap Myocutaneous and muscle only axial distant flaps 1. Pectoralis major 2. Lattissimus dorsi 3. Sternomastoid 4. Trapezius 5. Platysma
- 31. Bakamjian andlittlewood 1964 Upper 3 perforating internal mammary artery branches Single stage reconstruction – anterior neck skin Two stage reconstruction – over neck structures to resurface distant sites
- 32. Ariyan describedit in 1970 pectoral branch of acromio thoracic artery Large skin territory – can be harvested in supine position
- 33. Local flaps& regional flaps plays an important role in head & neck reconstruction When using local flaps in the head & neck preoperative planning of the flap is prime importance Grafts are reliant on blood supply of recipient site but flaps takes their blood supply with them