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