Flashcards in Axial pattern flaps Deck (45):
Axial pattern flaps are cutaneous flaps based on a named nutrient vessel
Axial pattern flaps have a pedicle containing a named cutaneous artery
T Vs random pattern flaps whose blood supply is based on the subdermal plexus
The paramedian forehead flap has a pedicle most commonly based on the supratrochlear artery
The abbe flap has a pedicle based on either the superior or inferior labial artery
The dorsal nasal rotation flap has a pedicle based on the dorsal nasal artery
Axial pattern flaps are usually staged surgical procedures.
Convex areas generally heal better with second intention than concave areas.
F Other way round.
Grafts rarely match the aesthetic results seen with flap reconstructive procedures.
The reduction of blood flow from the proximal to distal portion of the flap results in relative tissue hypoxia and challenges flap survival.
Flaps that have excessive width:length ratios may undergo distal necrosis.
F Excessive length:width.
Flaps inset under heightened tension show reduced perfusion.
Most flaps utilised in derm surgery are random pattern flaps.
Axial pattern flaps commonly used in facial reconstruction include the median and paramedian forehead flaps, the dorsal nasal flap, and the Abbe flap.
When most of a nasal subunit has been removed with tumour extirpation, the optimal reconstructive result may be achieved by replacing selective parts of the subunit.
F Replacing the entire subunit.
Random pattern flaps are an effective repair choice for nasal defects >2cm, alar or distal nasal defects, or full-thickness wounds
The forehead is generally preferred for nasal reconstruction when there is insufficient dorsal nasal skin.
The paramedian forehead flap and the cheek melolabial interpolation flap are both interpolation flaps with the base of the flap’s pedicle residing some distance away from the surgical wound (non-contiguous).
The cheek (melolabial) interpolation flap is a true axial pattern flap.
The paramedian forehead interpolation flap is a true axial pattern flap.
T Named vascular supply is the supratrochlear artery.
The cheek interpolation flap is suitable for defects on the nasal tip.
F Ala or lower nose, not tip.
The vascular supply of the forehead is supplied by four paired arteries: the dorsal nasal (angular) arteries, the supratrochlear arteries, the supraorbital arteries and the superficial temporal arteries.
For the paramedian forehead interpolation flap, undermining in a subfascial plane just superior to the periosteum near the flap’s origination ensures inclusion of the nutrient vessel within the body of the elevated flap.
Discontinuation of anticoagulants before axial pattern flaps is necessary.
For the paramedian forehead flap, incisions should go below the brow.
F Shouldn’t dt risk of distal flap necrosis.
Surgical scars present on the forehead may be associated with increased operative risk of flap necrosis when performing the paramedian forehead flap.
The paramedian forehead flap is designed based on the location of the supratrochlear vessels at approximately the medial end of the eyebrow.
The paramedian forehead flap’s base or pedicle is designed to be ideally 1.2-1.7cm in width.
The primary sources of auricular cartilage for composite grafting in the paramedian forehead flap are the conchal bowl and antihelix.
T Yield significant amounts of cartilage to reconstruct the lower nose.
When performing a paramedian forehead flap, additional flaps or grafts may be needed to improve the aesthetic outcome when repairing the donor site at the cephalic margin of the wound on the forehead.
F Unlikely to improve the aesthetic outcome.
For the paramedian forehead flap, the distal aspect of the axial flap should not be aggressively thinned of all muscle and subcutaneous fat.
F This allows the flap to drape over the cartilaginous framework of the nose and restore contour.
For the paramedian forehead flap, typically the pedicle is divided as a second-stage procedure at approximately post-operative day 21.
The dorsal nasal flap is utilised to repair defects of the nasal tip, supratip, or dorsum/sidewall that are less than 2.5cm diameter.
The success of a dorsal nasal flap is dependent entirely on the laxity of the dorsal nasal skin.
The more the dorsal nasal flap extends into the glabella, the easier the flap and secondary defect are to close without introducing anatomic distortion.
The Abbe cross-lip flap is a pedicled axial pattern flap supplied by the labial artery.
The labial artery is between orbicularis muscle and mucosa posterior to the vermillion.
The course of the labial artery remains unchanged throughout life.
F Becomes more tortuous and superficial w age.
For the dorsal nasal flap, inclusion of the angular artery in the base improves vascular support, allowing a more generous backcut
The dorsal nasal flap is a good option for defects up to 2.5cm in diameter in patients with any shaped nose
F Ok if large nose, but can compress the cartilage and change tip projection when repairing large defects in patients with thin noses
For the paramedian forehead flap, the pedicle is designed in a true vertical axis to ensure that the maximum length of the named vessel is included.
Curvilinear incision on the nose minimise the potential for postoperative trapdoor deformity.
F Should use more acute angles.
Conservatively undermining the surgical defect of the nose just above the periosteum and perichondrium before insertion of the flap may prevent postoperative trapdoor deformity.
When elevating the paramedian forehead flap, there is no need to avoid removal of calvarial periosteum.
F Removal will significantly slow second intention healing at the flap’s donor site.
For the paramedian forehead flap, the only common postoperative event is continued oozing from the transected pedicle near the glabella.