2. Introduction
• FLAP are vascularized 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)
4. Rotation flap
• Very large 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
6. Transposition flap
• Different from 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
10. Interpolation flap
• Rotated about a pivot point and inset into
defect near the donor
• example thenar flap for finger tip
• reconstruction
11. CLASSIFICATION OF FLAP
CIRCULATION PATTERN
• 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
12.
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
18. Based on Composition
SINGLE AND 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
Based on 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
20.
21.
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
Combined flaps –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
Back cut
Islanded flap, cut on all side but base still attached
margin of flap is raised and advanced along the axis of defect
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
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
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
