Basic Flap Design

Excerpt

A fundamental skill of reconstructive surgery is flap design and transfer to close tissue defects that cannot be sutured primarily. Given the diverse spectrum of tissue defects encountered in patients, ranging from small, skin-only defects to extensive, multi-tissue-type defects, and the various underlying causes, the skill set required for flap transfer must be adaptable and continually evolving as new techniques are described. Flaps are often employed for wound closure when substantial tissue loss occurs during trauma or as a result of oncologic resection. Classic examples include traumatic scalp avulsions requiring closure with latissimus dorsi free flaps and hemiglossectomies requiring reconstruction with radial forearm free flaps.

Understanding the anatomy and physiology of the defect and potential donor sites is critical to successful flap transfer, as is mastery of atraumatic soft tissue surgical technique. Ultimately, flap design and transfer represent the clinical intersection of the science of medicine and the art of surgery, which renders these procedures either immensely rewarding or singularly frustrating, depending on the outcome.