Rotation Flaps

Excerpt

A flap is used when more straightforward closure techniques, such as secondary intention, primary closure, or skin grafting, produce a functionally or cosmetically unacceptable result. Flaps can reduce and redirect tension, making them indispensable tools in wound closure. By using nearby tissue, flaps permit excellent skin color, texture, and thickness matching the recipient site. A skin flap uses a reservoir of tissue laxity to close a surgical defect known as the primary defect. The wound created by harvesting the flap is known as the secondary defect. Flaps, unlike grafts, remain attached to a vascular supply known as a pedicle. Local flaps, which use tissue adjacent to the primary defect for closure, are classified by their blood supply pattern. Axial flaps are supplied by a named artery, whereas random pattern flaps are supplied by the dermal plexus or unnamed musculocutaneous arteries.

It is common for flaps to be classified based on their primary motion as well. There are three basic types of tissue movement: transposition, advancement, and rotation. Transposition flaps, such as z-plasties, switch the positions of two or more areas of tissue to transfer skin into a defect. Advancement flaps recruit adjacent tissue to close a defect in a linear direction. Rotation flaps pivot adjacent tissue around an axis to close a primary defect, essentially rotating skin into the defect.