Flat Flap Transplantation

Flat flaps are traditional flaps or simple flaps. The flap is transplanted in a flat form, with only one pedicle as usual, and occasionally double pedicles. The length and width ratio of the flap should not exceed 1.5:1, but the length and width ratio of the flap can be enlarged in the blood-rich part or the flap containing the shaft cardiovascular. In the lower leg of the blood supply, the ratio of length to width should be 1:1, otherwise blood flow disorder may occur. The size of the flap can be selected according to the specific condition of the repair site. The direction of the flap should be designed according to the direction of the blood vessel, and the pedicle should point to the proximal end of the blood vessel. The donor site can be directly sutured or closed with a medium-thickness skin graft [Fig. 1]. Treatment of diseases: small bowel vascular malformation Indication Generally, deeper deformities cannot be repaired by skin flaps, or those with deep muscle tendons, nerves, bones, and large blood vessels need to be repaired with flaps. Preoperative preparation 1. Improve the general condition: If the patient has anemia, low plasma protein, dehydration, etc., it must be treated first. 2. The granulation wound needs to be prepared for a period of time, including unobstructed drainage, diligently changing the dressing and saline wet compress (usually wet for 2 to 3 days), proper pressure dressing, raising the affected limb, waiting for the germination color to be fresh and rosy, texture Solid edema, less secretion, no inflammation around the wound edge, can be skin grafting. If the granulation tissue is high, it is feasible to remove it. 3. Fresh wounds should be treated according to the debridement steps, so that the wounds have no active bleeding and necrotic tissue, and the edges are trimmed neatly. 4. The donor site should be shaved 1 day before surgery, brushed with soapy water, wiped dry, then rubbed with alcohol, wrapped with sterile towel, can not use strong disinfectant (such as iodine, etc.), so as not to damage the epidermis, reduce The skin is vital. Skin disinfection was performed with 1:1000 thiomersal and 75% alcohol during surgery. Surgical procedure Common methods of flap transplantation include z-rotation, local advancement, local lateral displacement, and distant metastasis. Z-shaped rotation method: This is one of the basic surgical methods for treating or preventing scar contracture. When a z-shaped (single or multiple) rotating flap (z-shaped or so-called flap) is used to treat a scar-like scar contracture, a surgical procedure using a relative triangular flap translocation is used to reconfigure the loosening of the skin tissue. In order to relax the contraction line and change the direction of the scar, the effect can be consolidated. The constricted line is taken as a common side, or the scar strip is cut to form a long and narrow wound surface, and one or more triangular flaps of the same size and shape are formed on both sides in the longitudinal direction, and then the flaps are respectively rotated and interchanged and then sutured. The length of the extension is proportional to the size of the apex angle of the flap, and is generally most suitably at an angle of about 60°. Local rotation method: The partial rotation flap is made by using the skin tissue around the wound edge to form a flap, which is rotated clockwise or counterclockwise to a certain angle, and transferred to the defect site to close the wound. When designing a partially rotating flap, the long diameter must be larger than the long diameter of the wound. Otherwise, the suture is too tight after transplantation. Not only the wound is easily broken due to tension, but also has a serious impact on the blood of the flap. Cut and separate the flap according to the design and rotate to cover the wound. After the flap is rotated, the skin defect on the near defect side of the pedicle may vary depending on the angle of rotation, and is called "cat ear". The larger the angle, the more obvious it is. This wrinkle can not be removed immediately, and should be left to be self-suppressed after surgery or to be repaired in another operation. Otherwise, the width of the pedicle can be narrowed, and the flap will be necrotic due to blood circulation disorder. Some wounds in the donor site after flap transplantation can be directly sutured, and some need to be closed. Local propulsion method: The local propulsion method is to use the extensibility of the skin to form a flap on the skin around the wound surface, and push the flap to the wound in a vertical direction to close the wound. The vy forming technique is such a method. According to the skin defect of the wound, a v-shaped incision is made on the skin on one side of the wound. The incision ends on both sides should be at an appropriate distance from the wound edge to maintain the blood supply of the flap. Separated under the skin to form a flap. Then, the flap is advanced, sutured to the wound edge, and the wound is closed. The donor site can be separated by a v-shaped cut edge and then pulled together for y-shaped suture. Similarly, y-shaped incision and v-shaped suture can be used to repair the wound [Fig. 4]. For long and narrow skin defects, a vertical incision can be made directly on both sides of the defect wound edge. A skin flap is formed between the incisions, and the skin is stretched forward to advance the wound. Local side shift method: In the wide wounds that can not be directly sutured, the skin is separated under the skin to form a double pedicle flat flap, which can be moved laterally to repair the wound surface. It is called a local lateral shift flap. It is commonly used to repair the longitudinal fusiform skin defect and bone in the anterior region of the calf. Organize exposed wounds. Take the skin defect of the calf as an example: an arcuate incision parallel to the medial wound edge on the inside of the calf wound surface should be cut to the plane of the wound surface and the lower end to facilitate the lateral grafting. In general, the ratio of length to width is preferably 1.5:1 (if the length of the flap exceeds 3 times the width, it is not suitable for immediate transplantation, and the suture is used in situ after incision, and delayed after 3 weeks). After transplantation, the donor site was implanted with medium-thickness skin grafts. Remote transfer method: The distal part of the donor site of the flat flap is called the distal flap, also called the hinge flap, such as the calf frontal area, which can be repaired with the contralateral calf flap; the finger wound can be used with the contralateral thoracic Avoid skin flap repair.