Principles of Wound Reconstruction – Skin Flaps (SPF and APF)

Vocabulary-style flashcards covering key terms related to cutaneous circulation, subdermal and axial pattern flaps, flap types, design principles, and common complications from the lecture on wound reconstruction.

Subdermal Plexus Flap (SDPF)

A flap that includes skin and subcutaneous tissue and receives blood supply from the collateral connections to the subdermal (SQ) plexus; a random-pattern flap.

Axial Pattern Flap (APF)

A flap nourished by a named axial vessel that runs along the axis of the flap, providing more reliable blood supply than a random-pattern flap.

Segmental arteries

Arteries that supply skin via three parallel plexuses: deep SQ plexus, middle cutaneous plexus, and superficial subpapillary plexus, enabling extensive collateral flow.

SQ (deep) Plexus

Deep arterial plexus within the subcutaneous tissue that contributes to skin blood supply.

Cutaneous (middle) plexus

Mid-layer arterial plexus supplying the skin.

Subpapillary (superficial) plexus

Superficial arterial network near the dermal papillae contributing to skin perfusion.

Random pattern flap

A flap without a named axial vessel, relying on the random subdermal plexus for blood supply.

Flap survival and collateral circulation

Flap viability depends on remaining cutaneous attachments and their vasculature providing adequate blood flow.

Advancement flap

A flap that moves skin forward without rotation; can be single- or bi-pedicle and includes techniques like H-plasty and V-Y plasty.

Rotation flap

A pivotal flap that moves on a curved arc around a pivot point; length is often reduced (~40%) when rotated through 180 degrees.

Burow’s triangle

Triangular excisions at the ends of a flap to permit movement and reduce dog-ears; commonly used with advancement and rotation flaps.

Transposition flap

A pivotal flap with a linear axis displaced from the defect; typically rotated 45–180 degrees into the wound.

Interpolation flap

A pivotal flap whose base is distant from the defect; the pedicle must pass over or under intervening tissue to reach the defect.

Plasty

A tissue-shaping procedure where tissue is altered (via advancement or rotation) to fit the defect, based on the flap configuration.

Distant flap (Pouch flap)

Flap created from skin not adjacent to the wound; often referred to as a pouch flap.

Pantographic expansion

A technique to gain extra flap length by divergent arms and back cuts in a single-pedicle advancement.

3:1 Rule

Flap length-to-width ratio that should not be exceeded (length should be no more than about three times the width).

Z-plasty

A transposition-plasty technique used to lengthen or reorient scars by rearranging skin in a Z-shaped pattern.

Hurow’s triangle (Burow’s triangle) and dog ear

Triangular wedges cut at flap ends to facilitate movement; commonly reduces dog-ear deformities.

Halsted’s Principles

Principles guiding tissue handling and flap elevation to preserve blood supply, including careful undermining and elevation away from SQ/muscle to reduce metabolic demand.

Recipient bed and granulation tissue (GT)

Before flap placement, ensure the wound bed has healthy granulation tissue; otherwise, postpone flap reconstruction.

Infection (complication)

Flap complication; can compromise a flap—use aseptic technique and ensure a healthy recipient bed before proceeding.

Seroma (complication)

Fluid accumulation due to dead space, more common in flaps from lateral flank/thorax; may require drains or compression.

Desensitization and self-trauma (complication)

Loss of sensation in the flap area can lead to self-trauma or persistent irritation.

Skin edge dehiscence (complication)

Separation of wound edges due to excessive tension, infection, seroma, or preexisting disease (e.g., DM, Cushing’s, prior radiation).

Global flap necrosis (complication)

Extensive loss of flap due to compromised blood supply; often iatrogenic or due to thrombosis/self-trauma; usually evident 2–3 days postoperatively and requires debridement of devitalized tissue.