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Transposition Flaps

My favourite Transposition Flaps   

André Borsche

Transposition flaps are important tools for plastic rconstructive procedures to cover  skin defects  in joint areas or wound defects  with bare bone or tendons. They often bring more soft tissue in the defect than Z-plasties or V-Y-plasties. But correct planning of the flaps is essential for the success. There are some important rules to consider :

 

1)      Transposition flaps are usually  random pattern flaps.

2)      The ratio of length to width depends on the vascularisation of the flap region.

3)      The flap is safer when you raise the flap near the basis as a fasciocutanous flap.

4)      Primary donorsite closure is preferable but only when there is little tension.

5)      Donorsite closure with skin grafts avoids tension on the flap.

6)      The direction of the primary donorsite closure should be 90° to the flap axis.

7)      Moderate longitudinal tension  on the flap is tolerable -  transversal never.

8)      Cavities  underneath flaps should be avoided and filled with vascularized tissue.

9)      Compression on the flap may cause necrosis and delay of the healing process.

10)   Hematomas may destroy flaps – therefore use small drainage tubes.

 

90° Transposition Flap

  • This flap brings a lot of tissue to the defect.
  • The primary donorsite closure is the limiting factor.
  • No tension on the flap when closing the donosite in 90° direction.
  • In the limbs antegrade or retrograde flaps are possible.
  • Donorsite closure proximal to the flap may cause venous problems.
  • Advantage in joint areas:  postoperative expansion is possible without contraction.
  • Closure of large defects needs a combination of flap and graft.

 

Transposition Flap with donorsite graft

  • This flap is universally available but not easy to plan.
  • The flap must be longer than the defect.
  • Measurements of the longest axis is mandatory.
  • Hematoma underneath the flap may destroy the take of the skin graft.

 

Rhomboid Flap (Limberg)

  • Very versatile flap with many variations in all directions.
  • Primary donorsite closure  without tension on the flap.
  • Excellent vascularity and safe healing.
  • Ideal for small reconstructions in the face.

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