Class 3 -GS- 2023- Dr.

Rasul Hamed
FLAP
A flap is tissue transferred from one site to another with its vascular supply intact.
This may consist of skin, subcutaneous tissue, fascia, and muscle .
Skin Flap - Unlike a graft, a flap has its own blood supply
Consist of skin and subcutaneous tissue that are transferred from one part of the
body to another with a vascular pedicle or attachment to the body being maintained
for nourishment.

Skin Flap Classification

A according to Location : (Proximity to defect)
1.Local flaps.
2.Regional flaps.
3.Distant flaps.

A according to Composition:
1. Cutaneous 2. Fasciocutaneous
3. Musculocutaneous 4.Osteocutaneous

ACCORDING TO THE WAY OF MOVEMENT

A. Pivotal flaps:
1-Rotational flaps. Flap is rotated in to the defect.
▪ 2-Traspositional flaps:
▪ 3-Interpolational flaps:
B. Advancement flaps. Single-pedicle , bipedicle , V-Y advancement flap

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ACCORDING TO BLOOD SUPPLY
A.Random flaps.
B.Axial flaps.

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1. Random pattern flaps
a. Blood supply is by dermal and subdermal plexus to skin flaps
b. Has limited length to width ratio (1.5-2:1)
c. Two types:
i. Those which rotate (rotation, transposition flaps - Z-plasty )
Z-plasty:
Is a technique in which two triangular flaps are transposed and
interdigitated with each other to revise and redirect existing scars or
to provide additional length in the setting of scar contracture.
• All limbs must be equal
• Gains length at expense of width
• Scar revision, move tissue to desired location

ii. Those which advance (single pedicle advancement, bipedicle advancement,

V-Y advancement, ,Y-V advancement)

2. Axial pattern flaps (arterial flap)

a) Blood supply by direct artery and accompanying vein
b) Greater length possible than with random f
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B. Uses
1. Replaces tissue loss due to trauma or surgical excision.
2. Provides skin coverage through which surgery can be carried out later
3. Reconstructing the full thickness of the eyelids, lips, ears, nose, and cheeks
4. Provides padding over bony prominences.
5. Covering recipient beds that have poor vascularity.
6. Improves sensation to an area (nerves to flap skin intact).
7. Muscle flaps may provide a functional motor unit or a means of controlling
infection in the recipient area (e.g.in chronic O.M.).

Disadvantages of the flap:

1. Usually bulky 2. Carry hair in non-hairy area 3. Leave scar over donor area

Factors leading to flap necrosis

1.Haematoma collection beneath the flap.
2.Tight suturing. 3. Tight dressing. 4. pressure from positioning
5.. Kinking of flap pedicle. 6. Cool ambient.
7.Nicotine, caffeine & other vasoconstrictive agents. 8.Technical errors.

Complications
1. Infection
2. Hematoma/ seroma
3. Cyanosis
4. Failure/ necrosis