- pedicle flaps can incorporate a variety of tissues, ranging from skin and subQ fat to essentially a complete finger;
- used to provide coverage in areas where tendon (denuded of epitenon), bone (denuded of periosteum), or joints are exposed;
- areas that must support tendon grafting or transfers are best covered w/ pedicle flap;
- periosteal surfaces can be skin grafted, but flap coverage provides more durable surface that is less prone to traumatic breakdown;
- pedicle flaps can be used to provide sensation or specialized tissues
- blood supply to pedicle flaps is thru intact base, stalk, or pedicle;
- donor site is closed primarily or is skin grafted;
- local flaps are obtained within the area of the defect and mobilized to fill the defect;
- regional flaps are further removed from the defect but raised on the same extremity;
- most regional and all distant pedicle flaps coverage requires at least two stages;
- in the first stage the flap is inset at the recipient site;
- more complete the inset at primary stage, more extensive vascular ingrowth into the flap;
- vascular supply of either local or distant pedicle flap can be enhanced by the staged division of a portion of its vascular supply
(delay maneuver), thereby encouraging a more efficienct circulation;
- this permits its use of a greater length to width ratio than would otherwise be possible;
- after flap has established sufficient vascular connections w/ recipient site, the second stage, pedicle transection and inset completion, is performed;
- Axial Pedicle Flaps:
- classified as either peninsular or island
- peninsular flaps maintain tissue continuity across the length of to the donor area;
- island flaps consist of an island of skin, muscle, fascia, or subQ tissue maintained on a debulked or skeletonized pedicle;
- flaps are often designed of greater dimension than initially estimated to avoid tension, since undue tension will initially impair venous return;
- tension associated with a single suture can produce a white line across a flap, resulting in distal necrosis;
- thick flaps are less pliable and compensations for their inelasticity must be made;
- pallor reflects inadequate arterial supply, while cyanosis indicates venous congestion;
- mottling, cyanosis, and and edema herald impending necrosis, and violet discoloration signals established tissue necrosis;
- hematoma or seroma between the flap and recipient bed will impair healing and predispose to infection and flap necrosis;
- hematoma can also reduce vascular flow thru direct pressure;
- Innervated Pedicle Flaps:
- innervated flaps are used primarily to provide coverage of the working (opposable) surfaces of the hand;
- this includes the ulnovolar surfaces of the thumb pad and the radio-volar surfaces of the finger pads;
- these flaps can be developed from local or regional tissues
Wound tension and blood flow in skin flaps.
Complications of 100 Consecutive Local Fasciocutaneous Flaps.
An Anatomic Review of the Delay Phenomenon: II. Clinical Applications.
Classification of the vascular anatomy of muscles: experimental and clinical correlation.
Muscle flap transposition with function preservation: technical and clinical considerations.
When does a random flap die?
Tissue oxygen measurements in delayed skin flaps: a reconsideration of the mechanisms of the delay phenomenon.
Enhanced capillary blood flow in rapidly expanded random pattern flaps.
Augmentation of blood flow in delayed random skin flaps in the pig: effect of length of delay period and angiogenesis.