Canis ISSN: 2398-2942

Skin flap: pedicle

Synonym(s): plastic surgery; reconstructive surgery

Contributor(s): Laura Owen, Daniel Smeak

Introduction

  • Wound reconstruction, eg carcinoma external nose Skin flap 08 carcinoma of external nose , following wide local excision Skin flap 04 skin deficit after wide local excision , hemangiopericytoma Skin flap 04 hemangiopericytoma over perineal region , deficit following compartmental resection Skin flap 12 deficit following compartmental resection or reconstruction of a traumatic wound, utilizing skin flap(s) retaining its original vascular supply.

Uses

Conventional flaps - random subdermal flaps

  • Vascularized solely by capillaries in subdermal plexus until neovascularization establishes a secondary blood supply from the recipient bed Skin flap 01 vascular arrangement of the random skin flap :
    • Advancement flaps Skin flap 02 advancement flap.
    • Rotation flaps Skin flap 10 reconstruction.
    • Transposition flaps Skin flap 11 transpositional flap Reconstruction of wound with transpositional flap.

Axial flaps

  • Vascularized by single direct cutaneous vessel Location of major direct cutaneous artery supply.
  • Common axial flaps include:
    • Caudal superficial epigastric for lower abdomen, groin and medial thigh.
    • Deep circumflex iliacs for lateral thigh and lumbar region.
    • Omocervical for cranial shoulder and cervical region.
    • Thoracodorsal for thoracic, forelimb and axillary region.
    • Caudal auricular for head.

Advantages

Axial flaps

  • Longer and more mobile than conventional flaps.
  • Mobility increased by:
    Either Complete detachment of skin: direct cutaneous vasculature left attached to donor site.
    Or Microvascular techniques used to re-anastomose to fresh vascular supply in local area of defect.
  • Intentional incorporation of an axial vessel in a flap improves blood supply to the distal region, improving results, reducing risk of wound infection.
  • Allows for long, narrow pedicles to transfer donor skin to remote areas.

Disadvantages

Conventional flaps

  • Viability determined largely by pedicle base width and vascularity Skin flap 01 vascular arrangement of the random skin flap.
  • Smaller and less mobile than axial flaps.

Axial flaps

  • Careful pre-operative planning and patient positioning to include axial vessel in reconstruction.
  • Technically more challenging.
  • Some techniques complex, eg microvascular anastomosis for orthotopic graft transfer.
  • Surgeon must ensure that axial vessel has not been damaged.

Requirements

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Preparation

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Procedure

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Aftercare

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Outcomes

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Prognosis

  • Good depending on site and extent of area to be repaired.

Further Reading

Publications

Refereed papers

Other sources of information


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