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extended out parallel from the wound, creating a rectangle with one edge remaining intact. This rectangle is freed from the deeper tissues and then stretched (or advanced) forward to cover the wound. The flap is disconnected from the body except for the uncut edge which contains the blood supply which feeds in horizontally. A rotation flap is similar except instead of being stretched in a straight line, the flap is stretched in an arc. The more complex transposition flap involves rotating an adjacent piece of tissue, resulting in the creation of a new defect that must then be closed.
288:
264:
428:. This allows for a larger area to be freed from surrounding and underlying tissue, leaving only a small pedicle containing the vessels. Reverse-flow flaps are a type of axial flap in which the supply artery is cut on one end and blood is supplied by backwards flow from the other direction. Random flaps are simpler and have no named blood supply; they are supplied by the subdermal plexus.
276:
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494:. The most notable risk in this procedure is flap death, where the flap loses blood supply. The loss of blood can be due to many reasons, but is commonly due to tension on the vascular supply and insufficient blood flow to the end segments of the flap. This can sometimes be fixed with another surgery or using additional methods of healing in the reconstructive ladder.
151:
201:. Blood is mainly supplied to the skin by two networks of blood vessels. The deep network lies between the dermis and the subcutaneous tissue, while the shallow network lies within the papillary layer of the dermis. The epidermis is supplied by diffusion from this shallow network and both networks are supplied by
325:
Distant flaps are used when the donor site is far from the defect. These are the most complex class of flap. Direct or tubed flaps involve having the flap connected to both the donor and recipient sites simultaneously, forming a bridge. This allows blood to be supplied by the donor site while a new
307:
Regional or interpolation flaps are not immediately adjacent to the defect. Instead, the freed tissue "island" is moved over or underneath normal tissue to reach the defect to be filled, with the blood supply still connected to the donor site via a pedicle. The pedicle can be removed after a new
208:
This robust and redundant blood supply is important in flap surgery, because flaps are cut off from other blood vessels when it is raised and removed from its surrounding native tissue. The remaining blood supply must then keep the tissue alive until additional blood supply can be formed through
301:
Local flaps are created by freeing a layer of tissue and then stretching the freed layer to fill a defect. This is the least complex type of flap and includes advancement flaps, rotation flaps, and transposition flaps, in order from least to most complex. With an advancement flap, incisions are
103:, which do not have an intact blood supply and relies on the growth of new blood vessels. Flaps are done to fill a defect such as a wound resulting from injury or surgery when the remaining tissue is unable to support a graft, or to rebuild more complex anatomic structures like breasts or jaws.
564:
where the tilemakers' caste would reconstruct noses using regional flaps due to the practice of nose amputations as a form of legal punishment. The next description of flap surgery comes from Celsus, an ancient Roman who described the advancement of skin flaps from 25 BC to 50 AD. In the 15th
225:
is a concept first coined by Ian Taylor in 1987. It is a three-dimensional region of tissue that is supplied by a single artery and can include skin, soft tissue, and bone. Adjacent angiosomes are connected by narrower choke vessels, and multiple angiosomes can be supplied by a single artery.
360:
Fasciocutaneous flaps contain subcutaneous tissue and deep fascia, resulting in a more robust blood supply and ability to fill a larger defect. The
Cormack and Lamberty classification is used for the vascular supply of faciocutaneous flaps. Examples: temporoparietal and anterolateral thigh
536:
within the first 2 days following surgery. After the immediate postoperative risk, the flap will continue to heal adhering to the stages of normal wound healing and will take over 3 months for an incision to be at 80% tensile strength compared to normal tissue.
569:, an Italian surgeon, helped develop the "Italian method" for nasal reconstruction, a delayed pedicle skin graft, where the skin from the arm would be attached to the nose for many months to create the reconstruction, first printed in the 1597 book
240:
Flaps can be fundamentally classified by their mechanism of movement, the types of tissues present, or by their blood supply. The surgeon generally chooses the least complex type that will achieve the desired effect via a concept known as the
40:
527:
Following flap surgery, the biggest risk in recovery is flap death. Flap failure is an uncommon occurrence but does happen. The reported flap failure rate in free flaps is less than 5%. The most commonly cause is by
1510:
Tomba P, Viganò A, Ruggieri P, Gasbarrini A (2014). "Gaspare
Tagliacozzi, pioneer of plastic surgery and the spread of his technique throughout Europe in "De Curtorum Chirurgia per Insitionem"".
560:
Skin flaps are an essential part of a surgeon's toolbox in plastic surgery. It is part of the reconstructive ladder. The first known reports of surgical flaps originated in 600 BC in India by
347:
Cutaneous flaps contain the full thickness of the skin, fat, and superficial fascia and are used to fill small defects. These are typically supplied by a random blood supply. Examples include
600:, microvascular surgery advancements allowed for the anastomosis of blood vessels. This led to the ability of free tissue transfers, and in 1958 Bernard Seidenberg transferred a part of the
365:
1230:
Carrau, Ricardo L.; Vescan, Allan D.; Snyderman, Carl H.; Kassam, Amin B. (2008-01-01). Myers, Eugene N.; Carrau, Ricardo L.; Eibling, David E.; Ferguson, Berrylin J. (eds.).
205:, and by perforating arteries that bring blood from deeper layers either between muscles (septocutaneous perforators) or through muscles (musculocutaneous perforators).
1427:
Kroll SS, Schusterman MA, Reece GP, Miller MJ, Evans GR, Robb GL, Baldwin BJ (December 1996). "Timing of pedicle thrombosis and flap loss after free-tissue transfer".
147:). The main goal of a flap is to maintain blood flow to tissue to maintain survival, and understanding the anatomy in flap design is key to a successful flap surgery.
551:
in 1917. The surgery was some of the first to use a skin flap from an unaffected area of the body and paved the way for a sudden rash of improvements in this field.
767:
326:
blood supply from the recipient site is formed. Once this happens, the bridge can be disconnected from the donor site if necessary, completing the transfer. A
1688:
1475:
Chambers JA, Ray PD (November 2009). "Achieving growth and excellence in medicine: the case history of armed conflict and modern reconstructive surgery".
433:
Pedicled flaps remain attached to the donor site via a pedicle that contains the blood supply, in contrast to a free flap, where the vessels are cut and
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Anyone who is unstable for surgery should not undergo flap surgery. As with most surgeries, people who are sicker may have more difficulties with
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1548:
1241:
1146:
1112:
847:
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Taylor GI, Palmer JH (March 1987). "The vascular territories (angiosomes) of the body: experimental study and clinical applications".
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Cormack GC, Lamberty BG (January 1984). "A classification of fascio-cutaneous flaps according to their patterns of vascularisation".
508:
As with healing of any wound, healing of a flap maintains the same process of wound healing. There are four stages to wound healing:
226:
Knowledge of these supply arteries and their associated angiosomes is useful in planning the location, size, and shape of a flap.
387:
369:
Breast reconstruction using the latissimus dorsi muscle and an implant. This is an example of a pedicled musculocutaneous flap.
1575:
Plastic
Surgery of the Face Based on Selected Cases of War Injuries of the Face, Including Burns; With Original Illustrations
901:
Houseman ND, Taylor GI, Pan WR (June 2000). "The angiosomes of the head and neck: anatomic study and clinical applications".
395:
Bone flaps contain bone and are used when structural support is needed such as in jaw reconstruction. Example: fibula flap.
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235:
612:. Modern advancements in flap surgeries have continued since this time and are now commonly used in many procedures.
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1283:
Saint-Cyr M, Wong C, Buchel EW, Colohan S, Pederson WC (December 2012). "Free tissue transfers and replantation".
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547:, the first person to receive plastic surgery, before (left) and after (right) skin flap surgery performed by
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Flaps may include skin in their construction. Skin is important for many reasons, but namely its role in
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581:, who pioneered facial reconstruction during World War I using pedicled tube flaps on patients like
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1609:"Immediate reconstruction of the cervical esophagus by a revascularized isolated jejunal segment"
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Song DH, Henry G, Reid RR, Wu LC, Wirth GA, Dorafshar AH (2007). "Chapter 2: Grafts and Flaps".
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Buchanan PJ, Kung TA, Cederna PS (September 2016). "Evidence-Based
Medicine: Wound Closure".
189:, and blood supply aid in flap survival. The skin can be divided into three main layers: the
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and are used when wounds are large, complex, or need tissue and bulk for successful closure.
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Flaps can contain many different combination of layers of tissue, from skin to bone (see
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Guyuron B, Eriksson E, Persing JA (2009). "Chapter 9: Microsurgery and Free Flaps".
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is lifted from a donor site and moved to a recipient site. Flaps are distinct from
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fascocutaneous flap, lateral fasciocutaneous flap, posterior fasciocutaneous flap.
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consisting of 54% of all causes. Venous insufficiency is commonly caused by a
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Turner AJ, Parkhouse N (July 2006). "Revisiting the reconstructive ladder".
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to provide bulk that can fill a deeper defect. If skin cover is needed, a
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Surgical procedure in which tissue is transferred with intact blood supply
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577:. Major advancements in modern plastic surgery are mostly attributed to
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myocutaneous flap and deltopectoral flap for head and neck defects, and
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flaps can be used to reconstruct tubular structures like the esophagus.
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Advancements continued in flap surgery. With the introduction of the
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Clark JM, Wang TD (November 2001). "Local flaps in scar revision".
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Flaps can be classified by the content of the tissue within them.
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573:. The Italian method was rediscovered in 1800 by German surgeon
491:
425:
1335:"From the reconstructive ladder to the reconstructive elevator"
1607:
Seidenberg B, Rosenak SS, Hurwitt ES, Som ML (February 1959).
838:
Guyuron B, Eriksson E, Persing JA (2009). "Chapter 8: Flaps".
1028:
Mellette JR, Ho DQ (January 2005). "Interpolation flaps".
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Tschoi M, Hoy EA, Granick MS (April 2005). "Skin flaps".
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The distribution of the blood vessels in the skin of the
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which does not have its own blood supply and relies on
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Chapter 105 - Reconstruction after Skull Base
Surgery
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Raising of microvascular flaps: a systematic approach
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Musculocutaneous and muscle flaps contain a layer of
1236:. Philadelphia: W.B. Saunders. pp. 1061–1068.
57:
32:
524:, all of which can take up to a year to complete.
416:Classification based on blood supply to the flap:
131:from the recipient site. Flaps have many uses in
353:deep inferior epigastric perforator (DIEP) flaps
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766:: CS1 maint: location missing publisher (
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1105:Plastic Surgery: Indications and Practice
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840:Plastic Surgery: Indications and Practice
111:Flap surgery is a technique essential to
686:Plastic Surgery: Essentials for Students
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382:can be placed over top of it. Examples:
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48:depicting flap surgery used to cover an
688:. Plastic Surgery Education Foundation.
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979:Boyce DE, Shokrollahi K (March 2006).
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29:
1333:Gottlieb LJ, Krieger LM (June 1994).
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571:De Curtorum Chirurgia per Insitionem
420:Axial flaps are supplied by a named
490:, damage to nearby structures, and
308:blood supply has formed. Examples:
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66:
1689:Surgical procedures and techniques
1208:The arterial anatomy of skin flaps
1141:(2nd ed.). Berlin: Springer.
1107:. Vol. 1. Saunders Elsevier.
958:10.1097/01.prs.0000222224.03137.d5
842:. Vol. 1. Saunders Elsevier.
25:
1211:. London: Churchill Livingstone.
1205:Cormack GC, Lamberty BGH (1986).
735:Grabb and Smith's plastic surgery
450:, which include individuals with
1625:10.1097/00000658-195902000-00002
1441:10.1097/00006534-199612000-00017
1352:10.1097/00006534-199406000-00027
915:10.1097/00006534-200006000-00001
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388:transverse upper gracillis flap
1679:Oral and maxillofacial surgery
738:(8th ed.). Philadelphia.
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637:List of plastic surgery flaps
585:, and the development of the
236:List of plastic surgery flaps
123:. This is in comparison to a
1489:10.1097/SAP.0b013e3181bc327a
1393:10.1097/PRS.0000000000002775
1297:10.1097/PRS.0b013e31826da2b7
1184:10.1016/0007-1226(84)90049-3
880:10.1016/0007-1226(87)90185-8
355:, and V-Y advancement flaps.
1135:Wolff KD, Hölzle F (2011).
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320:for breast reconstruction.
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174:
1512:Eur Rev Med Pharmacol Sci
1082:10.1016/j.cps.2004.11.005
1042:10.1016/j.det.2004.08.010
575:Carl Ferdinand von Graefe
67:
37:
997:10.1136/bmj.332.7543.710
981:"Reconstructive surgery"
437:to another blood supply.
587:walking-stalk skin flap
1387:(3 Suppl): 257S–270S.
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474:Risks or complications
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117:reconstructive surgery
89:reconstructive surgery
622:Breast reconstruction
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249:Mechanism of movement
243:reconstructive ladder
234:Further information:
153:
145:§ Classification
798:10.1055/s-2001-18831
598:operating microscope
530:venous insufficiency
1578:. Forgotten Books.
1572:Gillies HD (2019).
1543:. Springer Vienna.
1429:Plast Reconstr Surg
1381:Plast Reconstr Surg
1339:Plast Reconstr Surg
1285:Plast Reconstr Surg
946:Plast Reconstr Surg
903:Plast Reconstr Surg
567:Gaspare Tagliacozzi
199:subcutaneous tissue
1537:Erovic BM (2015).
589:by Gilles' cousin
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484:fluid accumulation
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293:Transposition flap
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162:is referred to as
83:is a technique in
46:John Eric Erichsen
1585:978-0-259-73591-5
1550:978-3-7091-1172-7
1243:978-1-4160-2445-3
1148:978-3-642-13831-7
1114:978-1-4160-4081-1
1036:(1): 87–112, vi.
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786:Facial Plast Surg
745:978-1-4963-8824-7
732:Chung KC (2020).
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464:immunosuppression
442:Contraindications
177:Human skin layers
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1062:
1060:
1056:
1051:
1047:
1043:
1039:
1035:
1031:
1030:Dermatol Clin
1024:
1021:
1016:
1012:
1007:
1002:
998:
994:
990:
986:
982:
975:
972:
967:
963:
959:
955:
951:
947:
940:
937:
932:
928:
924:
920:
916:
912:
908:
904:
897:
894:
889:
885:
881:
877:
874:(2): 113–41.
873:
869:
862:
860:
856:
851:
845:
841:
834:
832:
830:
828:
826:
824:
820:
815:
811:
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803:
799:
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751:
747:
741:
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736:
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724:
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702:
700:
698:
696:
692:
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680:
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667:
663:
660:
658:
655:
653:
652:Rotation flap
650:
648:
645:
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640:
638:
635:
633:
630:
628:
625:
623:
620:
619:
615:
613:
611:
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584:
580:
576:
572:
568:
563:
555:
550:
546:
542:
538:
535:
531:
525:
523:
519:
518:proliferation
515:
511:
505:
504:Wound healing
497:
495:
493:
489:
485:
481:
473:
471:
469:
465:
461:
457:
453:
452:comorbidities
449:
448:wound healing
441:
436:
432:
431:
427:
423:
419:
418:
417:
411:
406:
402:
399:
398:
394:
393:
389:
385:
384:gastrocnemius
381:
377:
373:
372:
367:
359:
358:
354:
350:
346:
345:
344:
338:
333:
329:
324:
323:
319:
315:
311:
306:
305:
300:
299:
289:
281:Rotation flap
277:
265:
248:
246:
244:
237:
229:
227:
224:
216:
214:
212:
206:
204:
200:
196:
192:
188:
184:
178:
170:
165:
161:
157:
152:
148:
146:
138:
136:
134:
133:wound healing
130:
126:
122:
118:
114:
106:
104:
102:
98:
94:
90:
86:
82:
72:
62:
60:
56:
51:
47:
44:Engraving by
41:
36:
31:
19:
1660:Flap surgery
1616:
1612:
1602:
1574:
1567:
1539:
1532:
1515:
1511:
1505:
1483:(5): 473–8.
1480:
1476:
1432:
1428:
1384:
1380:
1342:
1338:
1288:
1284:
1278:
1247:. Retrieved
1232:
1225:
1207:
1200:
1175:
1171:
1165:
1137:
1104:
1098:
1073:
1069:
1033:
1029:
1023:
988:
984:
974:
952:(1): 267–8.
949:
945:
939:
906:
902:
896:
871:
867:
839:
789:
785:
734:
685:
632:Hand surgery
608:to remove a
595:
570:
559:
526:
514:inflammation
507:
477:
445:
415:
342:
239:
220:
211:angiogenesis
207:
180:
171:Skin anatomy
163:
142:
121:blood supply
110:
97:blood supply
81:Flap surgery
80:
79:
33:Flap surgery
18:Flap surgery
1266:|work=
1178:(1): 80–7.
657:Skin cancer
647:Rhinoplasty
435:anastomosed
339:Tissue type
256:Local flaps
203:collaterals
1673:Categories
1594:1152260318
1249:2022-10-30
754:1091585260
668:References
583:Walter Yeo
545:Walter Yeo
522:remodeling
510:hemostasis
502:See also:
405:intestinal
380:skin graft
175:See also:
125:skin graft
50:amputation
1664:eMedicine
1559:974391518
1268:ignored (
1258:cite book
1157:733542624
762:cite book
627:DIEP flap
606:esophagus
593:in 1930.
565:century,
328:free flap
316:flap and
223:angiosome
217:Angiosome
191:epidermis
1643:13627972
1613:Ann Surg
1524:24610608
1497:20431512
1457:20380107
1401:27556770
1313:22788028
1305:23190838
1217:12808179
1090:15814122
1050:15620622
1015:16565127
966:16816714
931:34422340
923:10845282
814:42728956
806:11735064
662:Z-plasty
616:See also
562:Sushruta
498:Recovery
492:scarring
488:bleeding
456:diabetes
454:such as
349:Z-plasty
59:ICD-9-CM
1634:1450976
1449:8942909
1409:5865301
1361:7661898
1192:6692066
1006:1410906
888:3567445
604:to the
602:jejunum
556:History
460:smoking
401:Omental
139:Anatomy
113:plastic
85:plastic
1641:
1631:
1592:
1582:
1557:
1547:
1522:
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1455:
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812:
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752:
742:
610:cancer
520:, and
466:, and
422:artery
376:muscle
197:, and
195:dermis
164:corium
160:dermis
158:. The
101:grafts
93:tissue
91:where
1453:S2CID
1405:S2CID
1309:S2CID
927:S2CID
810:S2CID
69:[
52:stump
1639:PMID
1590:OCLC
1580:ISBN
1555:OCLC
1545:ISBN
1520:PMID
1493:PMID
1445:PMID
1397:PMID
1357:PMID
1301:PMID
1270:help
1238:ISBN
1213:OCLC
1188:PMID
1153:OCLC
1143:ISBN
1109:ISBN
1086:PMID
1046:PMID
1011:PMID
962:PMID
919:PMID
884:PMID
844:ISBN
802:PMID
768:link
750:OCLC
740:ISBN
426:vein
424:and
221:The
115:and
107:Uses
87:and
63:86.7
1662:at
1629:PMC
1621:doi
1617:149
1485:doi
1437:doi
1389:doi
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1293:doi
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1180:doi
1078:doi
1038:doi
1001:PMC
993:doi
989:332
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954:doi
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