Intended for healthcare professionals

Student Education

Basic plastic surgery techniques and principles: Flap surgery

BMJ 2003; 327 doi: (Published 01 September 2003) Cite this as: BMJ 2003;327:0309322
  1. Ben Taylor, third year medical student1,
  2. Ardeshir Bayat, honorary lecturer and specialist registrar in plastic and reconstructive surgery1
  1. 1University of Manchester

In the fifth part of our series, Ben Taylor and Ardeshir Bayat explain the finer points of reconstructive flap surgery so there is no need for you to get yourself into a flap about it

Last month, we considered the lower rungs of the reconstructive ladder.1 At times, however, the simple steps are not sufficient, and the art of plastic surgery comes to the fore. The plastic surgeon can move pieces of tissue, known as flaps, around the body to create a desired end result. Here we provide a brief overview of the science behind flap surgery.

The concept of flaps

A flap, like a skin graft, is an autotransplantation of tissue. The main difference between the two, however, is that a flap takes its original blood supply with it, whereas a graft is completely stripped of its blood supply during transfer. Because of this, flaps can be made thicker, and can do a lot more than skin grafts. Flaps are used when a skin graft is unsuitable or would leave the defect with inadequate bulk. Flaps are more resistant to infection than grafts,2 and they allow you to go back into the wound for second stage repair. In addition, microsurgical techniques allow the flap to have some motor or sensory function, even reanimation of a paralysed face.3

Flaps were used to repair noses as long ago as 600 bc in India.4 But historically, flaps have had their limitations, as Harold Gillies wrote in 1957, “Plastic surgery is a constant battle between blood supply and beauty.”5 In the past 40 years, advances and rediscoveries in understanding the viability of flaps and their blood supply have given surgeons more freedom.

Flap jargon explained

Primary defect--defect to be filled

Secondary defect--hole left by raising the flap

Pedicle--entry point of the blood …

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