Tubagus Izzul Barr Yusuf

EPIDERMIS
DERMIS
 EPIDERMIS
No blood vessels.
Relies on diffusion from
underlying tissues.
Stratified squamous
epithelium composed
primarily of keratinocytes.
Separated from the dermis
by a basement membrane.
 DERMIS
Composed of two sub-
layers: superficial
papillary & deep reticular.
The dermis contains
collagen, capillaries,
elastic fibers, fibroblasts,
nerve endings, etc.
Any tissue used for reconstruction or
wound closure that retains all or part of its
original blood supply after the tissue has
been moved to the recipient location.
 It can be used to:
Cover poor recipient bed
Cover joint contractures
Cover open fractures or joints
Import blood supply in infected or irradicated
wounds
Reconstruct specific structures
 It can be classified by site, geometry, tissue
composition or blood supply.
 Local Flaps area of tissue transferred to an
adjacent recipient defect. Commonly used in
reconstruction of face and hand.
Regional Flaps flap that is elevated from a
site in the vicinity of the primary defect but is
not contiguous with it.
Distant Flaps the tissue taken from a donor
site distant from the defect.
Free Flaps movement of the tissue from 1
site to another along with its blood supply.
 Advancement often produce small
triangular bulges at their base which require
excision.
Transposition or rotation flap the defect is
triangulated. If the wound after flap cannot
be closed, it is usually covered with skin graft.
Island a piece of tissue is circumscribed
completely on a vascular pedicle containing
its blood supply and then transferred to the
defect, sometimes passing under an adjacent
bridge of skin.
 Pivotal flap
curvilinear
standing cone results
two borders
broad based
Uses - cheek, forehead
 Rhomboid, dufourmental, bilobed

Linear axis
Rotated over intact skin
Pivot point
Versatile
 Geometry
measure, remeasure
Rhomboid
60 & 120 degree angles
Dufourmental
60 to 90 degree angles
4 choices
 Double transposition flaps
Original description
90 degree arcs
final 180 degree arc
Arcs of 90 to 110 degrees preferrable
Uses - lower third of nose
 Sliding movement
adequate undermining
standing cones created
Types
monopedicle, bipedicle, V-Y, A-T, cheek
Uses - forehead, brow
 Forehead, Brow
3:1 ratio
Burows triangles
 Forehead, Brow
Disadvantage
long suture line
 Bilateral advancement
triangular defect
Uses - hairline, brow, lip
 Advancement
Some rotation
Uses - medial cheek, nasofacial sulcus
Prevent complications (ectropion)
 Axial pattern - angular artery
Inferior and superior flaps
Uses - lower 2/3 of nose, perinasal area,
upper lip
pin cushioning, blunting of nasofacial sulcus
potential ectropion, scleral show
 Inferiorly based
 Superiorly based
 Replace tissue loss due to trauma or surgical
excision
Provide skin coverage through which surgery
can be carried on later
provide padding over bony prominences
Bring in better blood supply to poorly
vascularized bed
Improve sensation to an area (sensate flap)
Bring in specialized tissue for reconstruction
such as bone or functioning muscle
 Pain reliever
Wound care
hydrogen peroxide, antibiotic ointment
Sutures removed at 5-7 days
Direct sunlight avoided for 2-3 months
Dermabrasion - 6-12 weeks
Revision - 6 months
 Infection
Hematoma
Cyanosis
Failure/necrosis
 Skin Grafts Flaps
Rely on the wound bed for blood Tissue has its own blood supply
supply

No size limit (SSG) / Relative size Size limited by its territory of

limit (FTSG) blood supply

Take on clean wounds, paratenon, Survive independent of wound bed

periosteum, perichondrium

SSG donor site heals in 12-14 days Donor site direct closure or SSG

Donor site may reused Single-use donor site

FTSG donor site closed directly or

by SSG