Flaps in Head & Neck

Reconstruction

MODERATOR:

Dr . Arun Kumar .K.V

PRESENTER:

Dr . Ananth Kumar.G.B

Contents

INTRODUCTION

HISTORY

RECONSTRUCTIVE

LADDER

PLANNING

CONSIDERATIONS

SKIN FLAP PHYSIOLOGY

CLASSIFICATION

LOCAL FLAPS

REGIONAL FLAPS

DISTANT FLAPS

FREE FLAPS

MONITORING OF FLAP

MEASURES TO

INCREASE THE

VIABILITY OF FLAPS

FATE OF FLAP

COMPLICATIONS

SALVAGING

REFERENCES

A flap is a unit of tissue that is transferred from one site

(donor site) to another (recipient site) while maintaining its

own blood supply.

1440 : Dutch word "flappe" : something that hung broad

and loose, fastened only by one side

Introduction

Tansini first described the latissimus dorsi flap in 1896

Before 1963, oral and pharyngeal defects were closed primarily and

reconstructed with random pattern skin flaps or tubed-pedicled

flaps of skin from the trunk.

In 1973, Daniel and Taylor reported the first free flap,

In 1976, Panje and Harashina simultaneously described the use of

free flaps to reconstruct defects of the oral cavity.

In the late 1980s and early 1990s, the use of osteocutaneous free

flaps to reconstruct mandibular defects was advanced.

HISTORY

Reconstruction Ladder

The anatomy & physiology of skin, including color, texture,

appearance & amount.

Local muscle anatomy : vascular, nerve supply & lymphatic drainage

The aesthetics of the area

Possible sites for incision placement

Areas of local tissue availability i.r.t the area to be reconstructed

Planning considerations

NEUROVASCULAR SUPPLY TO

LOCAL SKIN FLAPS

The sensory nerves are distributed in a segmental fashion

Sympathetic nerves in the area of cutaneous arterioles

Precapillary sphincter- nutritive blood flow, local stimuli

Preshunt sphincter- thermoregulation, sympathetic stimulation

Segmental

Perforators

Cutaneous

Musculocutaneous

Septocutaneous

The subunit principle is only a starting

point, but it is the foundation for adequate

reconstruction of facial defects.

With the subunit principle, skin color, skin

texture, skin thickness, hair growth, and

surrounding contours at subunit junctions

are considered; these features can provide

optimal camouflage for incisions and

transition

The facial subunits

Based on blood supply

Axial Random

Mathes and Nahai classification

CLASSIFICATION

CLASSIFICATION

By method of movement from the donor site

1) Advancement flaps 2) Transposition flaps

3) Rotation flaps 4) Interposition flaps

By distance from donor site

Local Flaps

Regional flaps

By the tissues they contain

Skin flaps

Composite flap

Free flaps

Advancement flaps

Linear or rectangular configuration

Sub classification

Single pedicle

Bipedicle

V-Y flaps

Single-pedicle advancement flap

A rectangle of skin is moved forwardly elasticity of skin

The advancement creates a length discrepancy which creates

standing cone deformities

Local Flap