LOCAL FLAP

Local flap

Random pattern flap

Blood supply
Dermal-subdermal plexus
Musculocutaneous artery

Axial pattern flap

Blood supply
Arterial flap
Fasciocutaneous flap
Myocutaneous flap
Septocutaneous flap

Local flap

Random pattern flap

Tongue flap

Axial pattern flap

Nasolabial flap
Palatal flap
Buccal musculomucosal flap(BMMF)

Tongue flap

Tongue flap

Indication
Reconstruction after mass excision
Resurfacing of intraoral defect
Closure of fistula

Anatomy

Lingual artery
Dorsal branch ; posterior based flap
Deep lingual branch, sublingual branch ; anterior
based flap

Tongue flap

Advantage
Easy approach
Minimized defect of donor site
Good blood supply
Short operating time

Disadvantage
Temporary disfunction of tongue for 2~3
weeks
Covering of donor site by skin graft

Tongue flap

Methods
Preservation of tongue tip
Anterior part of Vallate papillae
Thickness ; 4~7mm
Width ; 2.5~3cm
length ; 5~6cm
Limited mouth opening and mandibular
movement
Second operation after 2~3 weeks

Tongue flap (case1)

Large palatal defect

involving the entire
hard and soft palate
after 3 attempts at
closing a recurrent
palatal fistula. Only a
small soft tissue band
persists as a remnant
of the soft palate.

Tongue flap (case1)

Inferiorly based
posterior pharyngeal
flap attached to the
posterior margin of
the tongue flap. Note
the lack of soft tissue
coverage of hard
palate
posterolaterally.

Tongue flap (case1)

Final result showing

closure of the soft
tissue gaps in the
posterolateral hard
palate using local
flaps.

Nasolabial flap

Nasolabial flap

Indication
Nose, nasal septum
Inferior eyelid, cheek
Oroantral fistula
Anterior mouth floor

Anatomy
Inferior ; branch of facial artery
Middle ; infraorbital artery
Superior ; angular artery

Nasolabial flap

Advantage
Good blood supply
Appropriate thickness
Similarity of skin color
Little hair of flap
Small shrinkage of flap
Small defect of donor site
Possibility in spite of Radiotheraphy

Nasolabial flap

Disadvatage
Esthetic problem ; asymmetric defect
Limited size of flap

Methods
Based in alinasal site
Length ; 7cm
Width ; 0.5~2.5cm

Nasolabial flap (case1)

(left) Preoperative frontal view of a 70-year-old male with

a melanoma of the right alar region.
(center and right) Preoperative markings showing planned
extent of resection and flap design

Nasolabial flap (case1)

(left) Intraoperative photograph showing inset of

the flap.
(Center, right) Four-month postoperative views.

Nasolabial flap (case2)

(left) A 54-year-old
man with a 2.0 2.0
cm defect following
excision of a basal cell
carcinoma.
(right) Three-month
postoperative view
showing thickening of
the flap.

Nasolabial flap (case3)

This defect was

reconstructed with the
classic nasolabial
skin flap and resulted
in less of a donor-site
deficit.

Nasolabial flap (case1)

(left) Patient with simultaneous defects of the cheek and

nose.
(center) Nonanatomic alar strut graft and superiorly
based nasolabial flap, with the pedicle at its most inferior
portion.
(right) Insertion of the flap.

Nasolabial flap (case1)

Full-face view of the patient 6 months after the

division and insertion of the flap.

Palatal flap

Palatal flap

Indication
Closure of oroantral fistula
Reconstruction of maxillary tuberosity
Large defect of extraction
Large palatal fistula

Anatomy

Greater palatine artery

Palatal flap

Advantage
Proximity to defect site
smallest defect of donor site
Good blood supply

Disadvantage
Limited flap size
Limited flexibility
Exposure of palatal bone

Palatal flap

Methods
consideration of Greater Palatine artery
no covering of palatal defect
Full recovery of donor site after 3 months

Palatal flap (case1)

(above)Preoperative
view of oro-antral
communication
(center)Illustration of
incision design
(below)Intraoperative
view of incision

Palatal flap (case1)

(above) Flap sutured

in position.

(below) Late
postoperative healing

Buccal flap

Buccal flap

Indication
Closure of oroantral fistula
Closure of palatal fistula
Reconstruction of mouth floor
Reconstruction of lip
Augmentation of alveolar crest

Anatomy
Anterior ; facial artery
Posterior ; buccal artery

Buccal flap

Advantage
Posterior movement of soft palate
Minimized imcomplete maxillary development

Smalleast post operative constraction

Two layer overlapping flap ; least fistula

Low velopharyngeal incompetence(VPI)

Buccal flap

Disadvantage

interruption of maxillary posterior development

Bulkiness of flap
imcomplete closure of anterior palate

Buccal flap

Methods

Transverse incision between hard palate and

soft palate

Patial thickness incision

Nasal mucosa ; 1.5cm Z-plasty

Bilateral buccal musculomucosal flap

Width ; 1.5cm
Direct closure of donor site

Buccal flap (case1)

Oral side incisions

outlined

Buccal flap (case1)

Anterior two-thirds of
hard palate closed on
nasal side with
turnover
mucoperiosteal flaps.
Nasal myomucosal
flap elevated. Nasal
buccal flap outlined

Buccal flap (case1)

Nasal buccal flap

elevated. Nasal
mucosal flap outlined
Nasal buccal flap
inset. Nasal mucosal
flap elevated and
inset.

Buccal flap (case1)

Nasal myomucosal
flap inset. Hemiuvulae approximated.
Nasal side closure
complete
Oral myomucosal and
mucosal flaps inset.
Oral buccal flap
outlined.

Buccal flap (case1)

Oral buccal flap inset. Buccal flap donor sites

closed primarily. Repair complete

Buccal flap (case2)

Commissure-based
buccal mucosal flap.
This is a randompedicled flap based at
the oral commissure
A commissure-based
buccal mucosal flap
can cover an entire
vermilion defect

Buccal flap (case3)

(Above) Kaplans
buccal mucosal flap
for palate
reconstruction.
(Below) The buccal
mucosal flap is turned
in for nasal lining, and
the donor site is
closed primarily

Buccal flap (case4)

(Above) right buccal

musculomucosal flap-nasal
mucosal defect. left bilobular
musculomucosal flap-oral
mucosal covering.
(Below) A bilobular
musculomucosal flap is rotated
to the oral mucosal defect.
Thus, one of the mucosal flaps
is turned over for the nasal
surface covering and the other
one (bilobate flap) is rotated to
cover the oral mucosal defect.

Palatal flap (Implant)

Diagram. Bucco-palatal view.

Distance between arrows, from
the most apical aspect of
buccal crest (c) to top of
implant body (i), was
measured.
Millimetric standard
periodontal probe, placed
parallel to long axis of the
implant, used to measure
distance from the most apical
aspect of buccal crest to top of
implant body. In the present
case, a 7 mm dehiscence was
recorded.

Palatal flap

Minimal buccal flap, including only

interdental papillae and marginal
gingival, exposing bone crest was
reflected. Note buccal bone defect,
evident following careful, atraumatic
extraction and elimination of
granulation tissue, epithelium and
bone inserting Sharpey's fibers from
bony walls.
Diagram. Implant in place (thick arrow).
A sharp deep internal beveled incision
delineating a pediculated full thickness
palatal flap was performed. An oblique
proximal incision facilitated rotation of
pedicle (empty arrow) which was wider
than 5 mm.

Palatal flap

Diagram. Palatal flap rotated

(arrows), tucked and sutured
under minimally reflected
buccal flap, covering grafted
implant site.

RPF sutured to buccal flap.

Portion of RPF covered by
buccal flap was deepithelialized previous to
suturing. Complete primary soft
tissue closure over implant site
was achieved.

Palatal flap

Additional sutures secure

RPF in the palatal tissues.
Surgical wound in the
palate, partially covered
by sub-epithelial
connective tissue, heals
by secondary intention.
. Implant site at time of
second stage implant
surgery, primary soft
tissue coverage was
maintained.