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Basics of local
flaps
Dr Tanmayee

HLRS, CMCH.
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Definition

 A flap is a unit of tissue that is transferred from donor site to

recipient site while maintaining its own blood supply.

 Originated from the 16th century Dutch word “FLAPPE” which

means “anything that hung broad and loose, fastened only by
one side”.
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Planning of local flaps

 True defect assessment

 Goals of reconstruction

 Biogeometric principles

 Reverse planning
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Classification

 Circulation

 Contiguity

 Configuration

 Components

 Conditioning
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Circulation

Random pattern: based on subcutaneous and intradermal supply

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Axial pattern: based on named artery.

• Direct
• Fasciocutaneous
• Musculocutaneous
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Configuration & Contiguity
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Pivot flaps
 Pivoting a flap with a cutaneous pedicle 45° from its in situ
position reduces the effective length 5%. A 90° and 180° pivot
reduces effective length by 15% and 40%, respectively.

 The reduction in effective length must be accounted for when

pivotal flaps are designed so that greater pivoting requires a
longer design of the flap.

 As the flap turns in an arc around its relatively fixed pivotal point,
redundant tissue, known as a standing cutaneous deformity (dog
ear), develops at the base.

 The greater the pivot of the flap, the larger the deformity that
occurs.
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 “Thus, increasing the flap’s pivot will …

change the flap’s shape, shorten the effective length, increase

wound closure tension, and deform the flap’s base by development
of a standing cutaneous deformity. To limit these restricting factors,
a flap’s arc of pivot should not exceed 90° whenever possible.”
 As flap pivots about point A, effective length of flap decreases along circumference B rather
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than C. Approximate percentage of shortening as related to degree of pivotal movement is
in parentheses.
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Concept of triangulation of defect

 In rotation flaps,Flap circumference should be 5–8 times the width

of the defect
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Moving end of the flap

moves twice the
distance of back cut,
which should be made
equal to half the side of
the triangular defect
PQ = GH / 2
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 Basic design of transposition flap:

Donor site is adjacent to the defect. The flap, whose advancing

edge is shared by the defect margin

1-triangulate defect.

2-CP=BC, APEX
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Configurations of Transposition flap
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Rhomboid flaps
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Dufourmental flap

 Short diagonal BD and

CD side extended.

 HDP bisected ; DE = CD

 EF = CD

 CDEF transposed into the

defect.
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 Bilateral and triple rhombic flaps

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 Z plasties at base of flap to facilitate transposition.

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Bilobed flap

 Double transposition

 Primary defect covered with secondary which inturn covered by another lobe.

 Total transposition was 90-110 degrees (45 degree for each lobe)
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Note flap

 (A) Design of an ideal note flap. The vertical tangential limb is

approximately 1.5 times the diameter of the defect and the
second limb lies at approximately 60 from the first limb and is
approximately the length of the defect diameter. (B) Note flap
elevation and mobilization. (C) Closure of the note flap.
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Z-plasty
•Involves transposition of two adjacent triangular-shaped
flaps.
•Can be used to:Increase the length of an area of tissue or
scar
•Break up a straight-line scar
•Realign a scar.
•The degree of elongation of the longitudinal axis of the Z-
plasty is directly related to the angles of its constituent
flaps.
• 30° → 25% elongation
• 45° → 50% elongation
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Four flap z plasty
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Five flap ‘jumping man’
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Seven flap Z plasty
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W plasty
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Advancement

 Flap is raised by technique of ‘Progressive retropositioning’ of

base

 Flap and the adjacent tissues must be undermined to facilitate

the linear advancement. Without undermining, the flap and the
pedicle could only be stretched and not advanced.

 Surgical effacement of the reclining cones that result due to

approximation of the unequal wound edges become
recognizable as the Triangle of Burow.
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Biogeometry
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 Advancement flaps : single,

bipledicle, V-Y

 Excising the Burow’s triangles

along the longer side

 Bilateral Z plasties at the base

of the flap (if the pedicle is
wide enough)

 Stark’s modification of
advancement flap design
(Pentographic Extension)
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Bipedicled flaps
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Keystone : trapezoidal flaps to close
elliptical defects
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V-Y advancement

 The size of the V base should match the size of the largest
diameter of the lesion

 Advancement along pivot plane with intact subcutaneous tissue.

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Interpolation flaps
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Island flaps
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Island flaps
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Composite flaps
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Pedicled flaps
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Application in hand surgery
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Pearls

• Prospective resection should not be compromised by a

preconceived plan of reconstruction.
• Treat the primary defect 1st ; Concern for secondary defect
should not endanger final result
• Always plan 10 to 20 % larger flap and review design after
final debridement
• Establish PIVOT POINT at the outset.
• Elasticity-viewed only as an added insurance
• Rule out any kink, twist or undue tension after inset of flap
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Thankyou !