Flap (surgery)

Flap surgery is a technique in plastic and reconstructive surgery where any type of tissue is lifted from a donor site and moved to a recipient site with an intact blood supply. This is distinct from a graft, which does not have an intact blood supply and therefore relies on growth of new blood vessels. This is done to fill a defect such as a wound resulting from injury or surgery when the remaining tissue is unable to support a graft, or to rebuild more complex anatomic structures such as breast or jaw. Flap surgery is a technique essential to plastic and reconstructive surgery. A flap is defined as a tissue that can be moved to another site and has its own blood supply. This is in comparison to a skin graft which does not have its own blood supply and relies on vascularization from the recipient site. Flaps have many uses in wound healing and are used when wounds are large, complex, or need tissue and bulk for successful closure. Common uses: Abdominal wall reconstruction Breast reconstruction Hand reconstruction Mandible reconstruction Rhinoplasty Scar revision Skin cancer "Plastic surgery is a constant battle between blood supply and beauty." - Sir Harold Gillies Flaps can contain many different combination of layers of tissue, from skin to bone (see classification section). The main goal of a flap is to maintain blood flow to tissue to maintain survival and understanding the anatomy in flap design is key to a successful flap and surgery. Human skin layersFlaps may include skin in their construction. Skin is important for many reasons, but namely its role in thermoregulation, immune function, and blood supply aid in flap survival. The skin can be divided into three main layers including the epidermis, the dermis, and the subcutaneous tissue. Blood is supplied to the skin mainly by two networks of blood vessels. The deep network lies between the dermis and the subcutaneous tissue, while the shallow network lies within the papillary layer of the dermis.