Flap Surgery
Flap surgery is a technique used in reconstruction concerning any type of tissue that is lifted from a donor site to be moved to a recipient site. Blood supplies must be intact. This may seem similar to a skin graft. A graft does not have an intact blood supply at the recipient site. A graft therefore relies on growth of new blood vessels. Flap surgery is done to repair or fill a defect or wound from injury or prior surgery. When the remaining tissue is unable to support a graft, or rebuild more complex anatomic structures such as breast or jaw, flap surgery is implemented.
Level of complexity is one way of classifying flaps. Surgeon should choose the least complex flap that will still achieve the desired effect. This concept is known as the reconstructive ladder.
Freeing a layer of tissue and then stretching this layer to fill a defect creates what is called a local flap . This least complex type of flap includes advancement, rotation, and transposition flaps.
Advancement flaps are formed by incisions extended parallel from the wound. This creates a rectangle leaving one edge intact. The rectangle is freed from deeper tissues and stretched forward to cover the wound in a process called advancement. With the flap disconnected from the body except for the uncut edge, blood supply feeds in horizontally.
Creating a rotation flap is similar to advancement except that instead of being stretched in a straight line, the flap is arced.
Finally, the more complex transposition flap rotates adjacent tissue. This results in the creation of a new defect. Further reconstructive surgery must then be performed in order to close this new wound.