Chap 1: Flap Design

pertains to procedure/ guidelines/ techniques in the proper execution and construction of a surgical flap

what is FLAP DESIGN

used to gain access or to move tissue from one place to another

what is a SURGICAL FLAP?

Objective and purpose of the surgery, Anatomical structures, Esthetic Consideration, Extent of diagnosis, Width of attached gingiva

Factors the AFFECTS flap design

1. Apex or tip of a flap should never be wider than the base unless a major artery is present at the base

2. Length of the flap must not be wider twice the width of the base

3. Axial blood supply should be included in the base of the flap when possible

4. Base of the flaps must not be excessively twisted, stretched or grasped with anything that might damage the vessels

Four Basic Flap Design Principles

Component, Circulation, Configuration, Contiguity, Conditioning

5C’s of flap design

Cutaneous, Fasciocutaneous, Fascial, Musculocutaneous, Muscle only, Osseoucutaneous, Osseous, Another component other than skin

COMPONENTS

Random Pattern Flap, Axial Patter flap

CIRCULATION

Island axial flap, Free flap

Axial Pattern Flap:

Advancement, Rotation, Transposition, Pedicle, Interpolation

CONFIGURATION

Flap is move in a straight line without rotation

what is ADVANCEMENT

vector of motion of flap is curved or rotational

what is ROTATION?

flap is rotated at a pivot point

what is TRANSPOSITION?

a narrow base of tissue is attached to the original site

what is PEDICLE?

flap is rotated at a pivot point to a nearby area but not adjacent to the defect

what is INTERPOLATION?

local flap: flap is immediately adjacent to the defect

regional flap: flap is moved from an adjacent region

distant flap: flap is moved from a remote anatomic area

CONTIGUITY

Pedicled Flap: flap is move with intact tissue bridge for support

Islanded Flap: flap is move under the skin for non-contiguous defect and with no intact skin/tissue

Distant Flap:

delay, tissue expansion, prefabrication

CONDITIONING