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Surgical flaps
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- 2. Skin - introduction •The skin – the interface between humans and their environment – is the largest organ in the body. • The surface of the skin is important as a biological layer for homeostasis. • Skin has three layers. Namely A) Epidermis B) Dermis C) Hypodermis
- 3. A) Epidermis • Outerlayer • It adheres to the dermis partly by the interlocking of its downward projections (epidermal ridges or pegs) with upwards projections of the dermis (dermal papillae) • contains no blood vessels. • Nutrition from underlying dermis by diffusion through basement membrane.
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- 5. B)Dermis • The depthof the dermis and the amounts of elastin and skin adnexal elements, such as sweat glands and hair follicles, vary depending on the functional requirements of the area concerned.
- 6. c) Hypodermis/ Subcutaneous layer •Dermis is divided into two parts (i) Papillary dermis – - thin top layer of dermis. -has C.T & blood vessels - nutrients to dermis (ii) Reticular dermis -thicker layer -dense connective tissue
- 7. SKIN – bloodsupply • The blood reaching skin originates from deep vessels. • There are two network of blood vessels - deep in dermis &sub cutaneous tissue - shallow in papillary layer of dermis.
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- 10. • A flapis a vascularized block of tissue that is mobilized from its donor site and transferred to another location, adjacent or remote, for reconstructive purposes. • This is in contrast to grafts where the tissue is detached and relies on nourishment from the recipient bed for its survival.
- 11. •Physiologic factors affectingflap survival :- i) blood supply to flap through its base ii) formation of new vascular channels between and the recipient bed iii) perfusion pressure of supplying blood vessels
- 12. Indications of flaps: • To cover the wider deeper defect • To cover over bone , tendon , cartilage • If skin graft repeatedly fails Advantages : • Good blood supply , good take up • gives bulk , texture, color to the area • Allows required movements in the recipient area. For example, jaw movements after pectoralis major flap after wide excision with hemi-mandibulectomy for carcinoma cheek . • cosmetically better
- 13. Disadvantage - • long–term hospitalization • staged procedure • Infection • necrosis Area where flaps are commonly used - *oral cavity * breasts * buttock * neck * limbs(leg) *bedsores
- 14. Classification Of Flaps– 1.ACCORDING TO BLOOD SUPPLY i) Random pattern flap ii) Axial pattern flap 2. ACCORDING TO SITE OF FLAP i) Local flap ii) Distant flap
- 15. According to bloodsupply 1. Random pattern flaps o vascular basis of flap is subdermal plexus of blood vessels. oNo known blood vessels supplying the flap. oLength: width ratio is no more than 1.5:1 oDelaying of flaps- a process in which the cuts are partially made and the flap is part lifted at 1st operation; it is then replaced, thus training the blood supply from a single border of the rectangle. At 2nd procedure it’s raised further n finally transferred.
- 16. 2. Axial patternFlaps- • Anatomically a known blood vessel is supplying the flap. • superficial vascular pedicles pass along their long axes • Long flaps and technique enables many long thin flaps to be safely moved across larger distance.
- 17. According to Siteof flap 1. Local Flaps • It is raised next to tissue defect in order to reconstruct. • There are different types of local flap. Can be broadly seen as :- A) flap rotating about a pivot point a. Rotational flaps b. Transposition flaps c. Z-plasty flaps d. bilobed and bipedicled flaps e. rhomboid flaps B) Advancement skin flap a. simple rectangular b. V-Y flap c. Y-V flap
- 18. Rotational Flap • forconvex surfaces. • Commonly used for coverage of sacral pressure sores. • can cover wounds of various sizes.
- 19. Transposition & Z-plasty flaps • most basic design • Leaves a graftable donor site • Rectangular flap rotated on pivot point • Creation of two triangular flap • length of both limbs must be same • Angle may vary
- 20. Rhomboid & Bilobedflaps for cheek, temple , back & flat surfaces. Defect must have 60 and 120 angle 2 transposition flaps sharing common pedicle. 1st flap to reconstruct defect & 2nd used for donor site.
- 22. Advancement flaps • Movedprimarily in a straight line from donor site to recipient site. • No rotational or lateral movements are applied. • V-Y advancement flap - advance skin on each side of a V- shaped incision to close the wound a Y- shaped closure.
- 24. 2. Distant flap •to repair defects in which local tissue is inadequate. • distant flap can be moved on long pedicles that contain the blood supply. •Pedicle may be buried beneath the skin to create an island flap or left above the skin and formed into a tube.
- 25. Most common meansof moving flap long distance while still attached:- Myocutaneous flap – long muscular pedicle that contains a dominant blood supply. fasiculocutaneous flap – long fasical layer that likewise contain a major blood septal blood supply.
- 27. Example of Typesof distant flaps :- I Forehead flap (based on anterior branch of superficial temporal artery) II Deltopectoral flap III Pectoralis Major flap IV Transverse rectus abdominis flap V Groin flap
- 28. Free Flaps • Withfine instruments and materials, it has become commonplace to be able to disconnect the blood supply of the flap from its donor site and reconnect it in a distant place using the operating microscope. • The free tissue transfer is now the best means of reconstructing major composite loss of tissue in the face, jaws, lower limb and many other body sites, as long as resources allow it.
- 29. Monitoring Of Flaps •Tissuecolor • warmth & turgor • assess Blanching • Capillary refill time
- 30. Causes of failureof flap poor anatomical knowledge while raising the flap. flap inset with too much tension local sepsis or in septicemic patients. dressing applied around pedicle is too tight.
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