Basic plastic surgery techniques and principles: 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 …