Flap plastic
Operative plastic-surgical techniques are referred to as flaps , which move ( skin ) tissue from a (dispensable) location of the same individual to a new desired location.
As a rule, these are pure skin flaps, but any tissue ( muscle , bones , fat ) with or without skin can be both pedicled (i.e. with its associated blood-supplying vessels and nerves as a pedunculated remote transplant ) and free (i.e. with connection to the blood vessels to the blood supply of the new environment). Exact knowledge of the anatomy of the blood vessels is essential for this flap surgery .
Flap sculptures are an ancient procedure for replacing lost tissue. The first description comes from India ( Indian-flap ), here the cut-off nose of adulterers was reconstructed from the skin of the forehead ( Indian nasal sculpture ). In Europe it was Heinrich von Pfalzpaint and later the Northern Italian Gasparo Tagliacozzi , who also reconstructed the noses of noblemen who had lost them in battle with an arm rag. Only the more precise anatomical knowledge allowed ever thinner and more flexible flap peduncles, which were thus much easier to bring to the required location. However, the stem of the flap with the blood vessels limits the radius into which this tissue can be brought.
The possibility of sewing smaller blood vessels under the microscope enabled so-called free flaps that could be completely separated from the body and then connected to the bloodstream at their new location via microsurgical anastomoses .
Close-up flap
A close-up flap is the term used to refer to smaller flap flaps , in which generally only the skin and subcutaneous tissue make up the flap. These flaps are generally larger than the defect they are intended to close and the base of the flap, i.e. H. the area where the flap connects to the rest of the skin must be sufficiently wide so as not to impair blood flow. A distinction is made between different types of proximal flap surgery:
- Gliding flap : also called subcutaneous pedicled island flap . Here, the skin that is moved into the defect is completely cut around and partially separated from the deeper layers. However, a basis remains so that the blood flow is not compromised. Then the flap is sewn into the defect, it "slides" so to speak on the base of the flap into the defect.
- Rotation flap: Here a flap is prepared and screwed into the defect. It is often necessary that excess skin that protrudes from the twisting must also be removed (so-called "Burow triangles").
- Displacement flap: similar to the rotation flap, but here the flap is not rotated into the defect, but shifted. There are also combined rotation-shifting flaps.
- Swivel flap : The flap is swiveled into the defect over healthy skin. Combined swivel flaps are z. As the bi-lobed flap , so a double thickness flaps, which looks similar to a B .
