ABC7’s More in the Morning crew spoke with Dr. Michael Kim about skin flap surgery. Flap surgery is a type of plastic surgery that uses tissues from another part of the body to close open wounds while having its own blood supply. Open wounds are an open invitation for bacteria. Loss of fluid takes place from these wounds. Therefore, the wound should be covered at the earliest with tissue obtained from another site.
The site from which the tissue is obtained is called the donor site, while the site where the tissue is transferred is called the recipient site.
Flaps used for plastic surgery have their own blood supply. Meaning, their own artery or vein. In this respect, they differ from skin grafts.
Flap surgery is necessary to cover deep open wounds. It is used when the wound or injury is associated with major tissue loss and deeper structures are exposed like bone, cartilage, tendons, or nerves.
What are the type of flap surgery?
Flaps are of two main types:
- Free flap: The flap with its blood vessel is disconnected and then attached to a blood vessel at a recipient site.
- Pedicled flap: Flap that has its blood supply with at least one artery and one vein.
Types of pedicled flaps include the following:
- Local Flaps: Local flaps are used from adjacent tissues. However, they can only be used for small to medium sized defects, and only locally. Depending on the way it is moved into the recipient site, the flap may be referred to as advancement (moves directly forward with no lateral movement), rotation (rotates around a pivot point to be positioned into an adjacent defect) or transposition flap (moves laterally in relation to a pivot point to be positioned into an adjacent defect)
- Regional Flaps: Regional flaps which are obtained from tissues that are close by but not immediately next to the recipient site. The flap is moved either over or under intact tissue to reach the recipient site. Once new blood vessels are formed from the donor site, the original blood supply can be cut off.
- Distant Flap: A distant flap is a flap that is obtained from a distant site of the body. it is the most complex type of flap. This type of flap is connected to both donor and recipient sites simultaneously forming a bridge in between them.
Flaps are classified broadly into three categories based on:
- Type of blood supply
- Type of tissue for flap
- Location of the donor site
Depending on the source of blood supply, flaps may be described as:
- Random flaps, when the blood supply comes from unrecognized blood vessels
- Axial flaps, when the blood supply comes from a recognized and named artery or vein
- Perforator flaps, which have small blood vessels that originate from a single large vessel.
- Reverse flow flaps, in which blood supply from the artery is cut at one end therefore backward flow of blood happens from the other direction. it is a type of axial flap.
A flap may contain a single type of tissue or multiple types. Depending on the tissues contained in the flap, the flap may be:
- Fasciocutaneous, which contains skin and fascia
- Adipofascial, which contains fat and fascia
- Myocutaneous, which contains muscle and skin
- Osseocutaneous, which contains bone and skin
- Tendocutaneous, which contains tendon and skin
- Sensory / innervated, which has nerve supply
- Cutaneous flaps, consisting of skin
- Muscle flaps
- Bone flaps
Even the most well-performed surgeries require adequate postoperative care. One drawback to flap surgery is that the donor site (where the flap came from) may scar.
Dr. Michael K. Kim stresses that in order to optimize your results it’s important to follow your physician’s instructions for wound care, scar care and any follow-up appointments that may be necessary to monitor your healing.