Basic Flap Designs for

Head & Neck

reconstruction
Presented by-
Dr. Sarwar Jahan Towhid
Indoor Medical officer
Dpt. Of OMS, DDCH
AUTHORS

Todd A. Schultz,

Jonathan S. Bailey,

Kelly Cunningham,
 • Journal of Oral Maxillofacial
Surgery - Clinic of North
America 26 (2014) 277–303.
• Division of Oral and
Source: Maxillofacial Surgery, Carle
Foundation Hospital, 611 West
Park Street, Urbana, IL 61802.
• E-mail address:
jonathan.bailey@carle.com.
History :
 The first documented repair of a complicated
nasal defect with a cheek flap occurred in Indiain 600 BC by
Sushruta Samita.
These procedures were continued in India, and it was eventually
documented in Western medicine in the late
1700s.
Tube flaps, delayed flaps, and transfer
flaps were used commonly during the 1500s.

 These techniques were documented by Taglia cozzi. During World War I,

Harold Gilies used
 tube flaps and delayed flaps with a greater
 emphasis on blood supply during defect reconstruction.
 These techniques were refined during
 the 1950s and again in the 1970s, maintaining an
The skin functions and properties include:
 Protection/ Anatomic barrier
 Thermoregulation
 Protection against excessive fluid loss/evaporation;
 Storage areas (eg, lipids and water) for synthesis
 Sensation center (heat cold, touch, vibration, pressure, injury); and
 Formation of an aesthetic zone, enhancing nonverbal communication/
expression.
Physiologic Characteristics of Skin:
The goal of proper flap design is to closely
restore the skin functions and properties :
Preoperative considerations should
include :
 Evaluation of smoking history, atherosclerosis, peripheral vascular disease,
 Steroid use,
 Diabetes,
 Previous surgeries;
 Extent of traumatic injury;
 Patient age and skin condition;
 Defect location.
Areas of greater esthetic concern :
 Hair line (forehead, temple, eyebrow, widow’s peak)
 Eyelid and orbital commissure
 Nasal (tip, nares, and ala)
 Oral vermilion and commissure
 Philtrum
 Ear (lobe and helix)
Good tissue donor sites :
 Neck and submental area (lax skin), mental/ chin area
 Cheek (lax skin)
 Periauricular area (lax skin)
 Forehead (limited laxity)
 Scalp (balding patient, limited laxity).
Classification of flaps may be defined by :
 Tissue configuration: Tissue configuration describes the geometric
shape of the flap. These flaps include rhomboid, bilobed, z-plasty, v-y
rotation, and others.
 Tissue layers: Cutaneous (skin and subcutaneous tissue),
Myocutaneous (composite of skin, muscle, and blood supply), and
Fasciocutanous (deep muscle fascia, skin, regional artery perforators).
 Blood supply : Random pattern (most common type & it uses the
dermal and subdermal plexus as its blood supply), axial pattern, or
pedicle flap
 Region : Local flaps ( Adjacent to the primary defect), Regional flap
donor sites are located on different areas of the same body part,
Distant flap ( different body parts are used as the donor site).
 Method of transfer : Advancement flaps, rotation flaps, transposition
flaps, interposition flaps, and interpolated flaps.
Local - Advancement Flaps include :
 Unipedicle or unilateral advancement flaps : Unipedicle or Unilateral
advancement flap designed as the width is based on the width of the primary
defect. Two incisions are developed parallel in nature to produce the length
of the flap. The total length of the flap should be 1.5 to 3 times the defect
width. Complete undermining from the distal to the proximal aspect of the
flap is required. Undermining the defect margins is recommended.
 Bilateral unipedicle advancement flaps :
 Bipedicle advancement flaps,
 Y-V advancement flaps,
 V-Y advancement flaps,
 Island advancement flaps.
An Interesting case:
Results
References:
Thank You . .
