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Flap reconstruction


Medical editor Truls Ryder MD
Plastic Surgeon

Oslo University Hospital
Norway

General

For some operations, it is necessary to perform skin flap reconstruction after a surgical resection to achieve coverage of the excised area, a better cosmetic result, and/or to restore functionality.

For the free flap technique, the skin tissue is transferred from one part of the body to another. The tissue's blood supply is divided and reestablished in the reconstructed area, using microsurgical techniques.

For the rotation flap technique, skin tissue, often with attached muscle, is dissected free while preserving the main blood supply. The flap may then be rotated from its original position to cover the defect. In these cases, the flap/tissue can only be used at a limited distance from the donor site.  

Indication

  • Closure of wounds after wide resection of skin. 

Goal

  • Cover difficult defects
  • Restore functionality
  • Obtain the best possible cosmetic result

Equipment

  • Plastic surgery instruments
  • Operation microscope (only for free flaps)

Preparation

  • The operation is carried out under general anesthesia.
  • Local anesthesia with adrenalin is applied to reduce bleeding.

Implementation

Free flap

A free flap reconstruction can be technically difficult and the operation time can vary from 6 to 12 hours.

  • The flap is dissected from the surrounding tissue, with at least one artery and vein intact.
  • One artery and vein in the recipient location is marked.
  • The vein and artery of the flap are ligated and the vessels divided.
  • The blood vessels of the flap and recipient location are anastomosed using microsurgery.
  • The flap is sutured to the area to be covered.
  • The donor area can usually be directly sutured.

Rotation flap

  • The flap is isolated with intact blood supply.
  • The flap is rotated directly, or through a tunnel under the skin, to the recipient location.
  • The flap is sutured to the desired location.

Follow-up

In the first days following the procedure, blood circulation in the flap should be observed closely. This is especially important for free flaps.

Wound cleaning/bandage changes should be carried out as needed.

Complications

  • Loss of parts of or the entire flap if the blood circulation clots. For free flaps, this may require an emergency reoperation.
  • Bleeding
  • Infection

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