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Wound management: simple skin flaps (Proceedings)

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Aug 01, 2011

Wound closure following extensive tumor resection or trauma may require reconstruction surgery. Skin can be borrowed from another location to accomplish closure without tension. Free skin grafts have been used with good success, but this procedure requires healthy granulation tissue, is technically demanding and requires intensive postoperative care. Skin flaps can be transplanted without the presence granulation tissue and a large amount of skin can be moved if a direct cutaneous artery and vein are included in the flap.

Classification of skin flap

Flaps are categorized according to 1) circulation, 2) various forms of compound, 3) location in relation to the recipient bed. A compound flap incorporates skin, and other structures such as muscle, fat or bone.

Circulation


Figure 1
According to the circulation classification we have subdermaal plexus or axial pattern flap. Dogs skin is fed through direct cutaneous artery running in the panniculus muscle. (Figure 1) Branches of the direct cutaneous artery supply the subdermal and the dermal plexus.

Survival of flaps used in dogs and cats elevated without including a direct cutaneous artery and vein depends on the deep or subdermal plexus: subdermal plexus flap. A pedicle graft incorporating a direct cutaneous artery is an axial pattern flap. They have an excellent blood supply and survived better than subdermal plexus flap.

Location

Flaps that are developed adjacent to the recipient bed are called local flap whereas flaps transferred from a distant region are termed distant flaps. Local flaps are commonly used for closure of defect that cannot be approximate by simple undermining and suturing. They depend on forming a flap in the neighboring area where loose elastic skin prevails. The secondary defect can be closed primarily. Distant flaps are used for major skin defects on the extremities. Local flaps are based on subdermal plexus blood supply while the distant flap are based on direct cutaneous artery.