Review Note

Last Update: 03/30/2025 10:48 PM

Current Deck: ACG Part 2::Plastic Surgery and Burns

New Card (Unpublished)

Currently Published Content


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Pending Suggestions


Field Change Suggestions:
SS_PB 1.2 Describe the different types of tissue flaps and the implications for flap survival
Ladder outlines increasing complexity of flap. 
  • Direct closure 
  • Autologous Skin Graft
    • Split-Skin Graft (SSG): Composed of epidermis and part of dermis, harvested with a power-driven dermatome. Donor sites heal in 2 weeks. Pain and itch at donor site (treated with NSAIDs, Panadol).
    • Full-Thickness Skin Graft (FTSG): Composed of epidermis and dermis, used in small areas where thickness, appearance, and texture are important (e.g., post-auricular skin for facial reconstruction).
  • Rotation or Pedicle Flaps
    • Rotation flaps: Arteriovenous connections intact, flap rotated to cover a neighboring defect. Examples include pectoral muscles for neck and latissimus dorsi for breast reconstruction.
  • Free Flaps
    • TRAM Flap: Free transverse rectus abdominis myocutaneous flap for breast reconstruction.
    • Free Gracilis Muscle Flap: Used for lower limb trauma coverage.
    • Free Radial Forearm Fasciocutaneous Flap: Used for oropharyngeal reconstruction after tumor excision.
Flaps can fail in 1% to 5% of cases, with the highest risk occurring in the first 2 days following operation

Implications for survival
  • Local flaps eg Rotation : rely on surrounding blood supply, vascular compromise can occur due to tension 
  • Pedicles flaps : maintain there own vascular supply but survival depends on preserving the pedicle and its blood flow during transfer. Trauma to the pedicle compromises 
Free flaps : depends on the microvscular anastomosis and re-establishment of blood supply. severity of microvascular damage and the risk of reperfusion injury are proportional to duration of primary ischemia time.