Flap

Defination:
A flap is a unit of tissue that is transferred from a donor to a
recipient site keeping its blood supply intact.
Utility: of Flap
1. To cover a defect – traumatic / non traumatic
2. To cover exposed bone, tendon, nerve, vessels
Types of Flap
A. According to structure
a. Cutaneous flap
b. Fascio-cutenious flap
c. Myo-cutaneous flap
d. Muscle flap
e. Osteo-myo-cutaneous flap
B. According to components
a. Skin or fasciocutaneous flap
b. Muscle or Myo-cutaneous flap
c. Composite ( Skin + Other tissue + cartilage + bone)
C. According to blood supply/circulation
a. Axial pattern
b. Random pattern
D. According to donor site/congruity
a. Local flap
b. Regional flap
c. Distant flap
i. Pedicle
1. Direct
2. Bridge
3. Tube
ii. Island
E. Anatomically
a. Abdominal flap
b. Groin flap
c. Hyppogastric flap
d. Inframammary chest flap
e. Cross finger flap
f. Arm flap
g. Thenar & hypothenar flap
h. Lattisimus dorsi flap
i. Skin flap of the face
F. According to
Movement/shifting/configuration
a. Advancement
b. Rotational flap
c. Transpositional flap
d. Free flap
G. According to conditioning
a. Instant and delayed

Brief description:
1) Cutaneous/ skin flap – Skin + Superficial fascia
2) Fascio-cutenious flap –
a. Skin + superficial fascia + deep fascia
 b. Example –
i. Abdominal flap
ii. Groin flap
iii. Leg flap
covering of expposed tibia
a. Upper 1/3rd – gastrocnemius flap
b. Middle 1/3rd – Soleus flap
c. Lower 1/3 rd – Fasciocutaneous flap
3) Muscle flap
a. Axial pattern
b. Example –
i. Gastrocnemius flap
ii. Soleus flap
iii. Rectus abdominis flap
iv. Latissimus dorsi flap
4) Myo-cutaneous flap
a. L
b. Gluteal flap
5) Osteo-myo-cutaneous flap
a. L
b. Clavicle + sternocleidomastoid to reconstruct – mandible
6) Axial pattern
a. L
b. Groin flap
7) Functionally axial pattern
a. L
b. Cross finger flap
8) Random pattern
 "Random" cutaneous flaps are
based on unnamed smaller vessels.
 The ratio of flap length to width is
a critical variable for flap survival.
 Random flaps can be reliable first
choices for coverage of smaller
 The term "random" really means
that the surgeon does not know for sure if there is enough
longitlldinally oriented (axial) vessels to keep the flap alive.
9) Free flap
a. Free flap technique involves the transfer of a flap whose
perfusion source is concentrated into a single arteriovenous
system.
b. Divided vessels are joined to suitable vessels, re-establishing
effective perfusion

Complication of flap
1. Tip necrosis
2. Infection
3. Total flap necrosis
Why radial artery based flap not used?
Ans : because – 1. Disfigurement
2. Radial artery is a reserve artery for coronary bypass graft