A Flap

Segment of mobile tissue that remains attached to a

portion of its ollginal blood supply. Any layer tissue can be raised

as a flap skin, fascial, muscle, bone, omental, others.

Pedicle :

The base by which the flap is

attached and includes the blood supply. Also include other tissue
Composite Flaps
Containing move than one tissue layer fasciocutaneous,
musculocuteneous, osteocutaneous omental jejunal etc.
- Flaps may be
charactermized by their blood supply.
Free Flaps
- Distinguished by their
defendence on a vascular anastomosis at the reciment site.

- A graft on the other hand survives on the blood supply at the

APPROACH TO PATIENT AND DEFECT
- Careful assesment ang planning.
- Careful analysis of the defct
and assesment os specific tissue deficiencies :

1. Location and size of defct.

2. Functional and aesthetic
consequences of original defect.

3. Potential donor site defect.

4. Vascularity of surrounding
tissue. 5. Presence of
exposed structures. 6.
Natural history of problem.
7. Cost of care.
 Free Flap Complek

Vistant Flap

Local Flap

Skin Graft

Direct Closure Simple

Flap Physiology
Blood Supply of The Skin
- important to be understood.
To defines the flap.
How
flaps can be moved.
- A rich network of vessels.

Patterns of blood supply to the

skin : -
Direct Cutaneous
- Fascio Cutaneous
- Muscula Cutaneous

Vascular plexuses of the skin

Regulation of Blood Flow
Extrinsic& intrinsic factors impinge on the
vasculature to regulated blood flow to the skin.
predominanty a function
of : 1. The
vessel
2. The circulating element in the blood
3. Interaction
between 1 & 2
Pharmacologic Manipulation of Flaps
Many approaches to pharmacologic flap
manipulation have been attemped to make a flap more robust before
transfer or to salvage a struggling flap.
No conclusive stdies show aclear benefit
with the use of any adjunctive treatment including, vasodilator,
rheologic agent, prostaglandins or prostalandin inhibitors, free radical
stravengers, allopurinol and streoid.

No consensus exists on the efficacy of these methods of
Flap Classification
 Reverse Flow Flaps

Venous flap.
Flow through free flaps the vascular
pedicle not only nourishes the flap covering the defect but also acts
as a conduit. These are useful for revascularzing tissue distal to a
defect. Supercharging

augmenting the blood suppy to a large pedicled flap

that may extend by performing a microvascular anastomosis to a
 Flap Monotouring

Clinical evaluation of :
- Temperatur
- Color
- Capilarry refill
-
Bleeding with puncture
- Turgor
A flap and surounding tissues should also be
assessed to identity a possible problem extrinsis to the flap such as :
- Hematoma
- Seroma
- Kinking