Local and Regional Flaps Alan S. Herford and G. E. Ghali Flap Principles There should be a progression from simple to complex treatments. Consideration should be given to primary closure or use of skin grafts first, followed by local, then regional, and finally, distant pedicled or microsurgical free tissue transfer. Flaps require additional incisions and tissue movement, which increase the risks of postoperative bleeding, hematoma, pain, and infection. Confirmation of tumor-free margins should be done before flap reconstruction if a malignant lesion has been excised Patient evaluation be performed. The body’s ability to heal and provide sufficient perfusion to the flap and adjacent tissues is critical for success. Assess possibility of impaired vascularity, such as a history of smoking, hypertension, and atherosclerosis Considerations should include the size and location of the defect, patient’s age, and the condition of the skin. With increased age and damage, the quality of skin, elasticity, and moisture content decrease. Some defects are amenable to closure with a single flap, but others require a combination of flaps for optimal results. Using multiple flaps for harvested from separate esthetic units can decreases the size of the 2ry defect and allow placement of scars between esthetic units. Q/ Difference between flap and graft? Flaps differ from grafts in that they maintain their blood supply as they are moved Q/ Cutaneous flaps supply through? - Abundant dermal and subdermal plexus allow for predictable elevation of random cutaneous flaps. A cutaneous flap may also have its arterial supply based on a dominant artery in the subcutaneous layer. Muscular perforating arteries are important contributors to the cutaneous vascular bed. Q/ What is the most important variable for flap viability? - Perfusion pressure and vascularity at the pedicle base. Because local flaps provide their own blood supply, they are particularly useful in patients with compromised recipient sites such as those that have been irradiated. Q/ Recovery of sensory nerve function in facial flaps is dependent on what factors? - On intimacy of contact between flap and recipient bed and on the viability of the type of restoration.
