Flaps Flashcards
What is the primary defect in relation to flaps?
It is the operative wound bed that requires repair
In terms of a flap, what is the secondary defect?
The secondary defect is the operative wound created by the flap elevation and closure of the primary defect
What is the primary tension vector of a flap?
Direction of the force resisting the movement of the flap body
What is the secondary tension vector?
Direction of force created by closure of donor site defect
What is the pivot point of a flap and what is critical to do in this area?
The point on the base of the flap that the flap will rotate around, critical to undermine around this area!
What is a “key stitch”?
The important first stitch that moves the flap onto the primary defect (can be between the edge or top of the flap in an advancement flap or the secondary defect on a rotational/transpositional flap (helps it stay in place)
What is an axial flap?
These are flaps that use a named vessel as their primary blood source
What are the most common axial flaps used in dermatology?
Paramedian forehead flap, dorsal nasal rotation “Rieger” flap, and theh Abbe cross-lip flap
What vessel supplies the paramedian forehead flap?
Supratrochlear artery
What is the vessel that supplies the dorsal nasal rotation “Rieger” flap?
Angular artery
What is the vessel that supplies the Abbe cross-lip flap?
The labial artery
What is a random pattern flap?
This is a flap that gets its blood supply from unnamed musculocutaneous vessels within the pedicle
The elevated portion of the flap is fed by the anastomotic subdermal and dermal vascular plexuses
Do advancement flaps alter the primary tension vector?
NO, they just redistribute tissue
What is the goal of an advancement flap?
To redistribute Burow’s triangle(s) away from free margins or to improve function/cosmetic outcomes
How does a rotation flap affect the primary tension vector?
Rotation flaps, unlike advancement flaps, DO redirect primary tension vectors along an arc adjacent to the primary surgical defect
Do advancement flaps or rotation flaps cause secondary defects?
Advancement flaps do not create secondary defects, rotation flaps do however
How tall and long must a rotation flap be relative to the primary defect?
Must be taller and longer, because the flap loses height and length when it is rotated
Where are the most common areas to use a rotation flap?
Large defects on the medial cheek, large defects on the scalp, and areas with curved skin tension lines like the chin and mental crease
For free margin protection: lower eyelid, nasal tip, and upper lip
Where is the tension vector on for transposition and interpolation flaps?
Transfers the tension from the primary defect to the donor site (goal to use a nearby but “nonadjacent” tissue reservoir)
What are some disadvantages of a single-stage transposition flap/
Pincushioning/”trapdooring”
There needs to be extensive/wide undermining to prevent this
What is the maximum length: width ratio for most flaps?
4:1
What transposition flap allows for a larger length to width ratio flap and why?
Interpolation (two-stage transposition) because they maintain a thick vascular pedicle that can be random or axial pattern
How long is a two-stage transposition pedicle kept in place before separating?
Usually 3 weeks
What are the main uses for the interpolation/two-stage transposition flap?
Large defects on the nose, large helical rim defects, and large lip defects