TO

Random Flap
Ribka Theodora

Grabb and Smith 7th Ed

Introduction

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

with its blood supply. Numerous classification schemes exist.
1. By their component parts (e.g., cutaneous, musculocutaneous, and
osteocutane­us)
2. Special relationship to the defect (local, regional, distant, or free),
3. Blood supply (random vs axial)
4. Movement that is required for the flap to fill the desired defect (e.g.,
advancement, pivot, trans­position, and interpolation).

Grabb and Smith 7th Ed

Introduction

 Skin and subcutaneous tissue was initially elevated as "random“ pattern flaps
either from a site adjacent to the wound or from a distant site.
 The term "random" really means that the surgeon does not know for sure if there
is enough longitudinally oriented (axial) vessels to keep the flap alive.
 Any flap requires an adequate blood supply after transfer to survive. "Random"
cutaneous flaps are based on unnamed smaller vessels. It was observed historically
that the ratio of flap length to width was a critical variable for flap survival. A
base-to­length ratio of 1:1 is usually safe.

Grabb and Smith 7th Ed

Random Cutaneous Flap
 Based on unnamed smaller vessels
 First choices for coverage of smaller defects
 Based on this subdermal plexus
 Ratio of flap length to width was a critical variable for flap
survival
 Allow elevation of skin and subcutaneous tissue  length :
width = 2–1.5 : 1

Thorne CH, eds. Grabb and Smith’s Plastic Surgery, 7th edition. 4
Chung K, eds. Grabb and Smith’s Plastic Surgery, 8th edition.
Thorn H, eds. Grabb and Smith’s Plastic Surgery, 7th edition.
Grabb and Smith 7th Ed
Delay Phenomenon

This is most commonly achieved by interrupting a portion of the normal blood

supply to the flap without transferring the flap from its native position. The
associated sublethal ischemia result in
(1) opening of "choke" vessels that are normally closed allowing blood flow into
the ischemic region of the flap,
(2) reorientation of the vessels within the £lap to a more lon­gitudinal pattern
(3) sprouting of new vessels within the flap through angiogenesis, and perhaps via
vasculogenesis.

Grabb and Smith 7th Ed

  The connections between adjacent cutaneous arteries are either by true
anastomoses, without change in caliber, or by reduced-caliber choke
anastomotic vessels (Figure 4.3).

Grabb and Smith 7th Ed

  In the skin, the anatomical territory of each cutaneous perforator forms a
basic angiosome module, defined by a perimeter of anastomotic vessels that
connects it with its neigh­bor in all directions

Grabb and Smith 7th Ed

Random Flap Types
Types of Random Flap

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1. Flaps Rotating about a Pivot Point

Thorne CH, eds. Grabb and Smith’s Plastic Surgery, 7th edition. 12
Bilobed Flap

Thorne CH, eds. Grabb and Smith’s Plastic Surgery, 7th edition. 13
Rhomboid (Limberg) Flap

Thorne CH, eds. Grabb and Smith’s Plastic Surgery, 7th edition. 14
2. Advancement Flaps

Thorne CH, eds. Grabb and Smith’s Plastic Surgery, 7th edition. 15
Complications

 Partial or complete necrosis.

 Seroma formation
 Hematoma formation
 Wound infection
 Dehiscence

Grabb and Smith 7th Ed

Case

Female, 36 y.o,
D/ Extravasation injury
a.r. antebrachii dextra
Plan to:
 Excision
 Local Flap

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Step-by -step
 Aseptic and antiseptic
 Remove all avital, damaged, or infected tissues
 Thoroughly clean the wound with normal saline
 Control the bleeding with diathermy and/ligation
 Design a bipedicled advancement local flap to the defect
 Inject vasoconstrictor agent around the flap design border,
wait for 7 minutes

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Step-by -step
 Make the incision according to the design beforehand through
the skin, subcutis
 Adequately dissect the plane, control the bleeding with
diathermy and/ligation
 Elevate the flap, carefully inset the flap to close the defect
 Suture subcutis, cutis, without tension

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Post Op
Thank You