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Flaps

A Mainstay of Surgical Reconstruction

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This gallery focusses upon the historic development and application of surgical flaps.

Flaps are an integral part of reconstructive plastic surgery. A flap is a piece of tissue that is partially detached from its original location and moved to cover a nearby wound or defect while maintaining its own blood supply. This is different from a graft, for instance composed of skin or bone, which is tissue completely separated from its blood supply and then relying upon on the site in which it is to be grafted for nourishment and to survive.

Plastic surgeons use flaps to bring healthy, well-vascularized tissue to replace missing or damaged parts and provide wound coverage for complex defects. These are wounds that cannot be closed by simple suturing alone or which require restoration of function. Sometimes they can be used to control chronic infection or enhance appearance after trauma, surgery, or birth differences. 

Flaps can be categorised in various ways, but we will look at them with respect to how their main blood supply is maintained. In order of general complexity, these are Local, Pedicled

The choice of flap depends on factors like the size and location of the defect, tissue availability, and the patient's overall health. They often require more complex surgery, longer operating times, and may have a higher risk of complications compared to simpler skin grafts. 

Flaps Vs Grafts

Blood supply: Flaps maintain their own blood supply, which is crucial for several reasons: a) Better survival in poorly vascularized areas b) Faster healing and integration with surrounding tissue c) Ability to withstand radiation therapy if needed post-surgery 

Tissue bulk: Flaps usually provide more substantial tissue volume, including subcutaneous fat or sometimes muscle. This is beneficial for: a) Filling larger and deeper defects b) Providing padding over bony prominences c) Improving contour and aesthetic outcomes

Functional restoration: Flaps can include various tissue types (skin, fat, muscle, bone), and combinations of them, allowing for: a) Restoration of complex three-dimensional structures b) Transfer of functional muscle units to restore movement.

Durability: Flaps generally provide more durable, hard-wearing coverage, which is important in: a) Weight-bearing areas b) Areas subject to repeated trauma or friction

Flexibility in design: Flaps provide almost limitless design possibilities to fit each unique defect. Plastic surgeons routinely customize flap shape and composition to better match the defect presented to them.

Sensory preservation: Some flaps can maintain nerve connections, potentially preserving sensation.

Infection resistance: The robust blood supply of flaps makes them more resistant to infection compared to grafts.

Scar contracture:Flaps are less prone to contracture than skin grafts, leading to better long-term outcomes.

 

 

Local pedicled fascio-cutaneous flap covering open fracture of the ankle, with a skin graft placed on its donor site.

 

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