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Dermatology
Flaps
Built from Dermatology, 5th Edition
What’s inside
13 sections · 125 slides
Overview
- What this topic covers
Introduction
Why understanding flap tissue dynamics matters in dermatologic surgery
- Why this knowledge matters
Background and Flap Fundamentals
The STARTS mnemonic, functional aesthetics, and the rules of good flap design
- A quick-recall checklist: STARTS
- STARTS mnemonic.
- The goal: functional aesthetics
- Preparing the wound edges
- Undermining and the "plate-like" scar
- Scar contraction and wound eversion
- How undermining changes scar contraction forces
- Hemostasis and suspension sutures
- Eversion of the wound edges
Flap Components and Movement
The shared vocabulary of every flap, and how tension shapes the result
- The shared parts of every flap
- Definitions of flap components.
- Anatomy of a flap: named parts
- Tension vectors
- Four ways to rearrange tissue
- Four ways flaps rearrange tissue
- Comparing the four flap categories
- Classification of flaps based on design characteristics. (category, variant, mechanism)
- Classification of flaps based on design characteristics. (category, variant, mechanism) (continued)
- Classification of flaps based on design characteristics. (category, variant, mechanism) (continued)
- Classification of flaps based on design characteristics. (category, variant, mechanism) (continued)
- Classification of flaps based on design characteristics. (category, variant, advantages)
- Classification of flaps based on design characteristics. (category, variant, advantages) (continued)
- Classification of flaps based on design characteristics. (category, variant, disadvantages)
- Classification of flaps based on design characteristics. (category, variant, disadvantages) (continued)
Burow's Triangle Displacement Flaps
Advancement and rotation flaps that displace a triangle to a convenient site
- Variants of Burow's triangle displacement
- Burow's triangle displacement flap types
- Key features of this flap group
- Single tangent advancement flap (Burow's flap)
- Double tangent advancement flaps (DTAFs)
- Double tangent advancement flap for eyebrow preservation
- Helical advancement flaps
- Using the helical advancement flap
- Helical rim advancement flap
- Dorsal nasal (Rieger) flap: design
- Dorsal nasal flap: blood supply and technique
- Dorsal nasal flap: when to avoid it
- Dorsal nasal (Rieger) flap
- Alar and spiral rotation flaps: overview
- Alar rotation flap (ARF): technique
- Alar rotation flap (ARF)
- Spiral rotation flap (SRF): technique
- Spiral rotation flap (SRF)
- Rotation flaps along curved tension lines
- Rotation flap (Mustarde flap) for a cheek and eyelid defect
- Crescentic advancement flap
- Crescentic advancement flap on the nasal sidewall
- Cheiloplasty (wedge closure) of the lip
- Cheiloplasty: technique detail
- Wedge closure (cheiloplasty) of the lip
Defect Reconfiguration: the Pedicled V-to-Y Flap
An advancement flap with its vascular base perpendicular to the skin
- The pedicled V-to-Y flap (PVYF): the idea
- Pedicled V-to-Y flap defect reconfiguration
- Two pedicle designs for the PVYF
- Pedicled V-to-Y flap: pedicle design variants
- The PVYF as a "rotated" rotation flap
- Rotation flap analogy for the pedicled V-to-Y flap
- PVYF: a tissue-efficient advancement
- Pedicled V-to-Y flap for a forehead defect
- Pincer flap: a PVYF for the cupid's bow
- Pincer flap for the cupid's bow
Tissue Reorientation Flaps
Transposition flaps that reorient laxity from an adjacent donor site
- Tissue reorientation: the idea
- The Z-plasty: the building block
- Z-plasty flap: directional tissue gain
- Z-plasty flap for a periocular defect
- Z-plasties hide inside transposition flaps
- Z-plasties embedded in transposition flaps
- Z-plasty tissue transposition, a further illustration
- Why the nasal tip needs reorientation
- Bilobed flap for a nasal tip defect
- The classic rhombic (Limberg) flap
- Dufourmentel and Webster modifications
- Variants of the rhombic flap
- Rhombic flap: where it works best
- Rhombic transposition flap on the nose
- The bilobed flap: two transpositions in series
- Bilobed transposition flap: Zitelli modification
- Planning and using the bilobed flap
- Bilobed flap for a distal nose defect
- Trilobed flap and rhombic flap with Z-plasty
- Trilobed flap for a nasal tip defect
- Rhombic flap with a Z-plasty
- Nasolabial (melolabial) transposition flap
- Nasolabial transposition flap
Tissue Importation Flaps
Bringing well-vascularized skin in from a distant donor site
- Tissue importation: the idea
- The paramedian forehead flap
- Planning the forehead flap
- The paramidline forehead flap variant
- Paramidline forehead flap for a nasal defect
- Raising and timing the forehead flap
- Nasolabial (melolabial) interpolation flap
- Nasolabial interpolation flap for an alar defect
- Retroauricular flap
- Retroauricular flap for a helical rim defect
- Spear's flap
- Spear's flap for an alar defect
- Tunneled flaps: single-stage tissue importation
- Subcutaneous tunneling island pedicle flap
- Island pedicle flap
- Paranasal-to-ala and retroauricular pull-through flaps
- Retroauricular pull-through flap (flip-flop flap)
- Nasolabial-to-lip pull-through flap
Combination Flaps and Site Selection
When more than one flap or a flap-and-graft combination is needed
- Combining flaps and grafts
- Respecting cosmetic subunit boundaries
- Combination flap and skin graft closure
- Combination flap closure across cosmetic subunits
- Matching flaps to their common sites
- Common locations for flap types.
- Common locations for flap types. (continued)
- Common locations for flap types. (continued)
Postoperative Care
Bandaging, bleeding prevention, and the standard follow-up schedule
- Common goals of postoperative care
- Preventing postoperative bleeding
- Preventing infection
- A standard bandaging protocol
- Follow-up schedule
Complications
Immediate, mid-term, and late problems after flap surgery, and how to manage them
- Immediate complications: bleeding and infection
- Mid-term complications: trapdoor deformity
- Late complications and revision
Summary
Pulling the flap toolkit together
- Key takeaways
References
Source citations from the chapter
- References
- References (continued)
- References (continued)
- References (continued)
- References (continued)
- Dermatology, 5th Edition (2-Volume Set)