Flap course Day1 Omdurman teaching hospital Upper limb & anterior trunk - revision

Flap course Day1

Omdurman teaching hospital

Upper limb & anterior trunk - revision

((Don't tell me the moon is shining; show me the glint of light on broken glass))

(Sense is the measure of the possible; it is composed of experience and prevision; it is calculation applied to life)

Thank to Mr. Osama Murtada & Mr. Ali

Axial Flap
Based upon a named artery. It is survival depends upon the artery not the width of the flap.

Random Flap
Has random unnamed vessels supplying it. Survival is directly proportional to the width of the flap.

Cormack & Lamberty classification:

They classified fasciocutaneous
flaps into three major types, differentiated by the

origin of the circulation to their “fascial plexus. ”  Type A

flap had multiple “fascial feeders ”  or perforators that did
not require specific identification, ( random
skin flap). Type B flaps contained a large, solitary septocutaneous
perforator. Type C flap relied on multiple and usually
Very small segmental septocutaneous branches, so that
elevation of these flaps almost always necessitated inclusion
of the source vessel with the flap in order to maintain their
complete integrity.

Survival length of the flap maybe increased by delaying the flap.

To delay a flap, elevate as a bipedical flap and return it to the flap’s bed. Two weeks later, elevate as a unipedical flap.

Flap course day 1 Omdurman teaching hospital Radial artery forearm flap

Flap course day 1
Omdurman teaching hospital
Radial artery forearm flap

It can be used as an island-skin flap, a free flap or as a compound forearm flap including vascularised nerve, bone or tendons.

The Radial Forearm Flap

Skin and fascia: optional tendon and bone

Innervation: No.

Blood supply: Radial artery and perforators from the radial artery.

Artery: Large caliber artery.

Vein(s): The venae of the radial artery can be small. The subcutaneous venous system or cephalic vein can be used for drainage, making for a larger caliber vessel.

Pedicle length: Can be dissected up to the takeoff from the brachial artery just distal to the antecubital fossa.

The course of the radial pulse is determine and the flap is outlined over the radial artery. The position of the flap can be pushed radially, ulnarly, or more proximally depending on the needs of the recipient area. Consideration should be given to the location of the cephalic vein if that is to be used for venous drainage.

The success of the RRFF flap depends on cutaneous perforators and the septocutaneous perforators.

Radial Forearm Osteocutaneous Flap: a segment of the radius can be harvested with the flap, in congruity with a portion of FPL muscle. It must be a unicortical block of volar radius, and no wider than 1.5 centimeters. The radius is prone to fracture is a segment of radius is harvested.

The reverse radial forearm fascial (RRFF) flap is widely used in the hand coverage in distal soft-tissue reconstruction . The traditional RRFF flap incorporates the radial artery from the forearm and is perfused by retrograde flow through the palmar arch.

 However, to produce this flap, a major artery to the hand must be sacrificed, which compromises the viability of the hand and may lead to ischemia. Some authors have recommended reconstructing the radial artery with a vein graft in a RRFF flap

Author: Terance (Terry) Ted Tsue, MD; Chief Editor: Arlen D Meyers, MD, MBA

Flap course day 1 Omdurman teaching hospital Foucher's First Dorsal Metacarpal Artery Flap

Flap course day 1

Omdurman teaching hospital

 Foucher's First Dorsal Metacarpal Artery Flap for Thumb Reconstruction