Skin flap plastic surgery was one of the most important discoveries in the history of plastic surgery, because it was thanks to this method that it was possible to close large skin defects. Such wounds can occur on the human body as a result of thermal or mechanical damage, as a result of surgical interventions to excise pathologically altered skin areas during oncological processes, and so on. But the use of skin flaps has its drawbacks, complications and risks. The requirements for survival of transplanted skin flaps are described by estet-portal.com.

What methods will help to ensure tissue survival in case of plastic surgery with a skin flap

Skin flap plastic surgery involves the transplantation of a skin flap on a vascular pedicle from a donor site to a recipient site. But the human body tends to reject transplanted tissues, thus protecting itself. Therefore, one of the important tasks of a plastic surgeon when performing plastic surgery with a skin flap is to prevent necrosis of transplanted tissues. It is important to pay sufficient attention to the viability of the skin flap during its cutting and grafting, while taking into account the size and location of the flap, its arterial inflow and venous outflow.

Plasty with skin flap:

  • how does the size of the flap affect its survival in skin flap repair;
  • delayed skin flap grafting technique;
  • immediate improvement of blood flow with skin flap plastic surgery.

How does the size of the flap affect its survival in skin flap repair

The following important points regarding the location and size of the skin flap should be assessed and taken into account before performing a skin flap repair:

  • there are no clear proportions of the length and width of the skin flap that determine the safe shape and size of the graft;
  • the width of the stem of the skin flap must be at least half of its length;
  • the blood supply to various areas of the skin decreases in the direction from the head to the legs, therefore, long flaps on one leg without the danger of losing them should be formed on the head and neck;
  • atherosclerotic vascular disease reduces blood flow to the flap, which should be considered in elderly patients;
  • The blood supply is also worsened by injuries, infections and radiation damage to the skin.

Delayed skin graft technique

In some cases, when a skin flap is performed, its survival may be ensured by a delayed graft. The delayed flap method involves the formation and transplantation of a skin flap in several stages. First, the flap is transferred from the donor area to the intermediate zone, and only after some time to the recipient. Important factors in the development of the delayed flap phenomenon are ischemia and sympathectomy. Mobilization of the flap leads to desympathization of arteriovenous anastomoses of the skin, and vasodilation is accompanied by dilation of the vessels supplying the flap and an increase in capillary blood flow, which leads to an increase in the survival rate of delayed skin flaps.

Emergency improvement of blood flow with skin flapplasty

Adequate blood supply is a major factor influencing the survival of skin flaps, so providing and maintaining it should be a priority during skin flap repair. But, unfortunately, situations in which there are still violations of the blood supply to the flap, take place. There are alternative methods to improve flap nutrition and prevent flap necrosis:

  • postural improvement in venous outflow improves outflow after elevation of the distal portion of the graft;
  • hirudotherapy helps to eliminate venous congestion;
  • blood flow in the flap increases its rhythmic compression by the vascular cuff every 2 minutes;
  • if a large amount of tension has been applied to the flap, returning it to the donor site may improve blood flow;
  • intravenous administration of low molecular weight dextrans improves circulation and reduces intravascular aggregation of blood cells.

If necrosis of a part of the flap still occurs, it must be removed as soon as possible, since the infectious process can spread to even more surrounding tissues, leading to their loss.

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