Below is a list of common and eponymous plastic surgery flaps with their classification and common usage. This is distinct from a graft, which does not have an intact blood supply and therefore relies on growth of new blood vessels. Ian macgregor 2,3 recognized the importance of an axial blood supply in flap surgery in the 1970s. Nursing monitoring and management of free and pedicled. Expeditious closure wounds one of the goals ofplastic. Basic understanding of reconstructive pre and postoperative patient management. There are as many types of flaps as there are types of injuries which might require the use of a flap. Sometimes, the flap is comprised of skin and fatty tissue only, but a flap. Cosmetic eyelid surgery, called blepharoplasty, is a surgical. Thus, the accessibility of medical knowledge and literature was the. Following a group teaching session, all healthcare providers provided input to create a flap monitoring chart. After a brief introduction of the concept and surgical rationale of perforator flaps, the book presents 24 different flaps from donor sites including upper limb, lower limb and the trunk. The major evolution in cosmetic surgery is the improvement in noninvasive procedures versus the standard large, open surgical approaches. With coverage of nearly twice the number of flaps as the previous edition, flaps and reconstructive surgery, 2 nd edition provides trainees and practicing surgeons alike with the detailed, expert knowledge required to ensure optimal outcomes.
A read is counted each time someone views a publication summary such as the title, abstract, and list of authors, clicks on a figure, or views or downloads the fulltext. Pdf surgical flaps in plastic surgery researchgate. Although the press and public often equate plastic surgery with cosmetic surgery, and tend to limit their understanding to this branch of the discipline, the vast majority of plastic surgery procedures carried out in the uk are in fact reconstructive. Reconstructive procedures american society of plastic. Complications such as complete flap loss can be catastrophic. Nov 10, 2015 other factors such as previous radiation or surgery in that area and what donor sites are available. Flap harvest requires accurate dissection of perforator vessels, which are often small, through muscle or fascia to yield adipocutaneous flaps from a multitude of donor sites. It includes chapters and expert commentaries from more than 100 authors and worldrenowned leaders in the field, while brandnew cases and high. Basic knowledge of reconstruction after oncologic procedures of the breast, melanoma and head and.
Diep deep inferior epigastric perforators flap surgery is a cuttingedge breast reconstruction procedure that uses a flap of complete tissue blood vessels perforators, skin and fat from a womans lower abdomen as donor tissue. A flap is a piece of tissue that is still attached to the body by a major artery and vein or at its base. Five stars from doodys star ratings a stepbystep manual on the use of reconstructive surgery flaps from planning to execution. Overview chapters on each major anatomical area provide a general approach to reconstruction, with detailed tutorials on workhorse flaps in the a to z section. This procedure uses excess skin and fat from the gluteal buttock region and. Flaps section details the multivariate usages of microsurgical flaps, pedicled flaps, perforator flaps, and more videos focus on the anatomy and basic principles of technique for a range of common flaps further delineating and simplifying flap surgery for the practitioner. Plastic and reconstructive surgery essential for student. Plastic surgery had its beginning nearly 3000 years ago, when sushruta, an indian surgeon, reconstructed the nose by transferring a flap of cheek and then. Reconstructive surgery is performed to treat structures of the body affected aesthetically or functionally by congenital defects, developmental abnormalities, trauma, infection, tumors or disease. Learn the techniques of gentle tissue management in skin closure, trauma burns, flap rotation and skin grafting. The term cosmetic surgery is used many times interchangeably and essentially signifies surgery that results in a beautification of the body.
Flaps can be classified by their blood supply into axial pattern flaps, which have a larger, typically named artery supplying their vascular needs such as the paramedian forehead flap, which depends on the supratrochlear arteries of the medial lower forehead, and random pattern flaps, which rely on the unnamed vasculature of the dermis, subcutaneous fat, and in some cases, the. A safe and reliable approach to the correction of such hernias utilizes external oblique muscle release with internal oblique muscle advancement and an extended mesh repair. Other factors such as previous radiation or surgery in that area and what donor sites are available. Women who do not have an adequate amount of abdominal tissue for a diep flap or siea flap reconstruction may be candidates for gap gluteal artery perforator flap breast reconstruction. Pdf textbookofplasticreconstructiveandaestheticsurgerydetail. Essentials for students university of kansas medical center. Basic knowledge of congenital facial and extremity birth defects. The masterclasses section is packed with state of the art innovations. We created and delivered a teaching session to junior nursing staff with regard the basic principles of flaps and their postoperative care and generated a universal postoperative flap monitoring protocol to help improve and standardize care provision.
Large, complex wounds of the forearm and many elbow wounds may require initial management with local, regional, distant, or free flap coverage reconstructive elevator figure 1 1, 6. A monitor of flap perfusion and oxygenation would allow the early detection of progressing flap ischaemia, hastening the required intervention and maximising the. Flaps and reconstructive surgery by fuchan wei and samir. Distally based sural fasciocutaneous flap was used for coverage in all cases and its survival, successful coverage of the defect and donor site morbidity studied. Nb the terms interpolation flap and pedicle flap can be used interchangeably. Fusing face and ocular biometrics raghavender jillela and arun ross west virginia university morgantown, wv, usa raghavender. Videos focus on the anatomy and basic principles of technique for a range of common flaps further delineating and simplifying flap surgery for the practitioner. Gap flap breast reconstruction prma plastic surgery. You are urged to read and reread this booklet before. Flap harvest requires accurate dissection of perforator vessels, which are often small, through muscle or fascia to yield adipocutaneous flaps from a.
Recommendations for the best reconstructive surgeons who do diep. A brief and concise introduction to the world of plastic and reconstructive surgery. Gap flap breast reconstruction aesthetic plastic surgery, pc. Plastic surgery can be broadly divided into aesthetic and. However, flaps used for reconstructive plastic surgery can be broken down into two main categories. Durrania adepartment of plastic and reconstructive surgery, addenbrookes hospital.
Farhadi a,b a department of plastic and reconstructive surgery, guys and st thomas hospital, westminster bridge road, london, uk. Perforator flaps allow the surgeon to recon struct body parts with the same tissues that are most frequently missing. With coverage of nearly twice the number of flaps as the previous edition, flaps and reconstructive surgery, 2nd edition provides trainees and practicing surgeons alike with the detailed, expert knowledge required to ensure optimal outcomes. Plastic surgeons have subsequently re defined cutaneous. Now that the main ways of classifying flaps have been introduced, the remaining sections of this article are devoted to the most important principles to remember before performing flap surgery.
Anterolateral thigh alt free flap surgery this leaflet has been written to help your understanding of anterolateral free flap surgery. Reconstructive surgery reconstructive surgery is the mainstay of a plastic surgeons work. The flap is then transferred to the chest where the surgeon, aided by a microscope, will attach the donor. Professor of plastic surgery cairo university 2014.
Women who do not have an adequate amount of abdominal tissue for reconstruction may be eligible for gap gluteal artery perforator flap breast reconstruction. Like any surgical procedure, flap surgery is not devoid of risk. Bulstrode and sabrina cugno approaches and techniques. Basic skin flaps and blood supply plastic and reconstructive surgery. May 06, 20 pedicled flaps distant flaps can be moved on long pedicles that contain the blood supply. Reconstructive surgery at hayatabad medical complex and said anwar medical centre peshawar. Flaps come from many different locations and are used in many different ways to accomplish the desired result. Plastic surgery is a unique medical specialty, derived from the greek plastikos, meaning to remodel, reshape and mold. This piece of tissue with its attached blood supply is used in reconstructive surgery by being set into a recipient site injured area onto which a flap or graft is placed.
Hussein khairy professor of vascular and general surgery, faculty of medicine, cairo university. However, for patients with insufficient abdominal tissue, it can still afford them natural looking results. Surgery needed to repair an abdominal bulge or hernia may require the use of abdominal muscle advancement flaps reinforced with mesh. Plastic and reconstructive surgery ebook pdf free download edited by ross d. Minimally invasive and officebased procedures in facial plastic surgery pdf jul 30, 20 posted by by medical books april 28, 2016 april 28, 2016 plastic surgery. Free flaps are regularly used in plastic and reconstructive surgery but have a significant failure rate due to vessel thrombosis in the reestablished arterial or venous circulation. Plastic surgery flaps uses 1replace tissue loss due to trauma or surgical excision 2 provide skin coverage through which surgery can be carried on latter 3 provide padding over bony prominences 4 bring in better blood supply to poorly vascularizedbed 5 improve sensation to an area sensate flap 6 bring in specialized tissue for reconstruction such.
Flaps section details the multivariate usages of microsurgical flaps, pedicled flaps, perforator flaps, and more. Diep flap reconstruction brigham and womens hospital. Moving flaps long distances while still attached are with a long muscularpedicle that contains a dominant blood supply a myocutaneous flap. Recommendations for the best reconstructive surgeons who.
Flap surgery involves transporting healthy, live tissue from one location of the body to another often to areas that have lost skin, fat, muscle movement, andor skeletal support. If you have any other questions that the leaflet does not answer or would like a further explanation, please ask your surgeon or cns. Flap surgery is a technique in plastic and reconstructive surgery where any type of tissue is lifted from a donor site and moved to a recipient site with an intact blood supply. The diep flap is the latest in microsurgical reconstruction flaps used mostly for the breast. Pdf plastic and reconstructive surgery ebook free fbfa. Flap revision surgery aesthetic plastic surgery, pc. The reconstructive ladder is an important concept in wound management. There are several different types of flap surgery methods that may be utilized, depending upon the location of the flap and the structures that need to be repaired. Textbook of plastic and reconstructive surgery ucl discovery. Farhadi a,b a department of plastic and reconstructive surgery, guys and st thomas hospital. Common suture techniques and simple flap techniques and their indications are also discussed. Free perforator flaps are perfused by fascial or myocutaneous perforators and evolved as a refinement of conventional myocutaneous free flaps. The use of pedicled muscle flaps in the upper extremity is notable in that it represents a use of new anatomic knowledge from mccraw and colleagues 107 in an application of established principles to treat the traditional problem of plastic surgery. One method of classifying flaps is by how they move.
Pdf postoperative monitoring of free flaps in uk plastic. Extra fat is removed, muscles are tightened, and skin is rewrapped around the face and neck to improve sagging facial. Wound characteristics including etiology, size, and orientation, as well as exposure of or injury to. Tissue is freed and rotated or moved in some manner from an adjacent area to cover the defect, yet remains attached to the body at its base and has blood vessels that enter into the flap from the donor site. The aims of this atlas are to introduce the clinical applications of perforator flaps in plastic surgery and skin replacement. The vascular plexus within the papillary body of the dermis. It has a rich history underpinned by innovative endeavour. Pdf classification of flaps and application of the concept of. Summary flap surgery is the essence of plastic surgery.
Expanded flaps delaying of the flap by tissue expanders inserted under the flap. Extra fat, skin, and muscle in the upper andor lower eyelid is removed to correct droopy eyelids. The accreditation council for graduate medical education and. Plastic and reconstructive surgery office for clinical affairs 515 2711629 fax 515 2711727 general description elective rotation this elective rotation in plastic and reconstructive surgery prs is a two 2 week experience in basic surgical. Sep 20, 2018 the diep flap is the latest in microsurgical reconstruction flaps used mostly for the breast.
It includes chapters and expert commentaries from more than 100 authors and worldrenowned leaders in the field, while brandnew cases and highquality. Bulstrode and sabrina cugno approaches and techniques published by wiley blackwell. Only the superfit and genetically blessed among us can get away without developing the under arm flab. Knowledge of the vascular supply of the skin is of fundamental importance for reconstructive plastic surgery, especially in designing skin aps for defect coverage. It includes chapters and expert commentaries from more than 100 authors and worldrenowned leaders in the. Free flap monitoring in plastic and reconstructive surgery. It is generally done to improve function and ability, but may also be performed to achieve a more typical appearance of the affected structure. Free flap reconstruction following lower leg trauma in the. Tissues are lifted from a donor site and moved to a recipient site with an intact blood supply what is a flap. Flap techniques used in reconstructive plastic surgery. Rotation flap movement is in the direction of an arc around a fixedpoint and primarily in one plane. The pedicle may be buried beneath the skin to create an island flap or leftabove the skin and formed into a tube. An evolutionary perspective on the history of flap.
Bipedicle flaps have been used to provide good quality soft tissue cover for defects in many anatom ical sites. Every woman bemoans the extra bulge she carries under her arms, which is why plastic surgery to lift the arm is becoming a popular cosmetic procedure. Pedicled flaps distant flaps can be moved on long pedicles that contain the blood supply. Nursing monitoring and management of free and pedicled flaps. Transposition flap the rectangular flap is rotated on a pivot point. Surgeons do and plan in advance on how to do it, allocating team members to do certain parts of the surgery simultaneously and getting the equipment needed to visualize where the perforating blood vessels are located. Postoperative monitoring of free flaps in uk plastic surgery units article pdf available in microsurgery 256.
103 264 12 184 63 942 1189 1585 847 1230 145 209 1291 884 9 955 1320 336 536 929 1019 576 296 1302 1220 189 1283 940 862 185 459