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Local Flap Technique
Unlike regional and free flaps, local flaps tend to have random pattern blood supplies, which means that there is no vascular pedicle per se, but rather that the subdermal plexus supplies oxygenated blood and provides venous drainage.
The myocutaneous flaps were described, where the skin relied for its blood supply on the multitude of small vessels perforating through the underlying muscle. Provided the muscle was raised on its blood supply, the overlying skin would survive, even when completely islanded.
The primary blood supply to the forehead flap comes from both the supratrochlear artery and the collateral flow at the medial brow region (terminal branch of the angular artery).
A skin flap is healthy skin and tissue that is partly detached and moved to cover a nearby wound. A skin flap may contain skin and fat, or skin, fat, and muscle. Often, a skin flap is still attached to its original site at one end and remains connected to a blood vessel.
A skin flap heals like a normal wound does. The flap is kept alive by the blood supplied by its own blood vessels. Over time, these blood vessels may grow and supply more blood to the area. Blood vessels in the flap that were cut usually connect with the blood vessels in the wound area.
You will need to undertake some lifestyle modifications based around showering and bathing for 2-3 weeks after surgery and avoid strenuous activity for around 3-4 weeks after surgery to ensure the graft site is not stretched or injured.
Bleeding, scar, and infection represent the most common potential complications with paramedian forehead flaps. Careful hemostasis and proper surgical dressings can decrease the risk of significant postoperative bleeding, as can patient avoidance of strenuous activities.
The flap receives its blood supply from the angular artery (a branch of the facial artery), the infraorbital artery, and the transverse facial artery [6].
The posterior arm flap (PAF) is an often-overlooked option in axillary reconstruction. The blood supply of the PAF is derived from an unnamed artery originating from the brachial or deep brachial artery which traverses the aponeurosis of the triceps brachii muscle near the termination of the tendon of the teres major.
As there is no direct blood supply to the epidermis, this outermost layer of the skin relies on the underlying dermis, for the supply of nutrients and disposal of waste products.
The epidermis itself is devoid of blood supply and derives its nutrition from the underlying dermis. The dermis is the underlying connective tissue framework that supports the epidermis. It further subdivides into two layers—the superficial papillary dermis and the deep reticular layer.
The epidermis does not contain blood vessels; instead, cells in the deepest layers are nourished by diffusion from blood capillaries that are present in the upper layers of the dermis.
Flap surgery is a complex surgery. Like any other major surgery, it also poses risks and complications like infection, bleeding, and blood clots. Other complications may include: Scarring.
The purpose of the flaps is to generate more lift at slower airspeed, which enables the airplane to fly at a greatly reduced speed with a lower risk of stalling. This is especially useful during takeoff and landing.
Skin grafts, in contrast to flaps, are completely removed from their blood supply, whereas flaps remain attached to a blood supply via a pedicle. Skin grafts are less technically difficult but can be more time-consuming as the procedure creates a second surgical site.
The superior labial arteries form a network around the upper lip. This network contains many branches that contribute to the blood supply for the upper lip, mucosal, and nose.
Your facial artery runs through a large part of your face, supplying blood to your muscles, mouth, nose and other areas.
The facial artery is also known as the external maxillary artery. It has a tortuous route along the nasolabial fold towards the medial angle of the eye. It passes deep to the digastric and stylohyoid muscles and it will pass through the submandibular gland.
Signs of a congested (venous compromised) flap include a bluish color, increased swelling and warmth, and shortened capillary refill (<2 seconds). In the case of ischemia (arterial compromised flap), the flap will be pale in color, cold, and will have a delayed capillary refill (>3 seconds).
The main disadvantage of a skin flap is that extra incisions are required which are sometimes quite large. Every effort is made to camouflage these incisions by placing them in the natural skin lines. Flaps may become infected or bleed like any other skin procedure. Occasionally the skin flap may breakdown.
Free flap surgery is considered a reliable and safe procedure for head and neck reconstruction. The success rate of a free flap described in the literature is about 95% 1-3.
The overall flap success rate was 92.6%. Over a third of patients (34.3%) had flap-related complications ranging from minor wound dehiscence to total flap loss.
Results. Overall flap success rate was 90%, with the radial forearm flap occurring to be most reliable (93%) in head and neck reconstruction.