Introduction

Authors: Liv Schöllhammer, MD, Frederik Gulmark Hansen, med.stud., Christian Kaare Paaskesen MD, and Magnus Balslev Avnstorp, MD

This chapter outlines essential knowledge for preparing, designing, and performing facial reconstructive surgery using local skin flaps. We begin with the basic principles of flap surgery, followed by an overview of specific facial flaps and their appropriate applications.

Definitions

• Local skin flap: A flap consisting of skin tissue adjacent to the excision defect. The primary movement determines the type of flap, such as rotation, advancement, transposition, or de-epithelialized turnover flap.

• Donor site: The area where the flap is harvested.

• Primary defect/Recipient site: The wound or tissue defect intended to be closed with the flap.

• Secondary defect: The defect at the donor site created during flap transfer to the primary defect.

• Primary tissue movement: The movement of the flap into the defect. For example, a flap rotated into the defect is called a rotation flap, while a transposed flap is referred to as a transposition flap.

• Secondary tissue movement: The displacement of surrounding skin during flap placement. This includes movement of skin towards the defect and the donor site. Careful consideration of secondary movement is essential to avoid aesthetic distortion, such as displacement of eyebrows, ala nasi, or lips.

• Undermining: An incision made beneath the flap or adjacent tissue, typically in the subcutaneous layer. This technique facilitates greater tissue mobility, allowing the flap to be positioned more effectively and reducing tension at the closure site.

Background

The term “flap” originates from the Dutch word flappe, meaning something attached on one side and free on the other.

The earliest documentation of local flaps dates back to ancient India, specifically in the Sushruta Samhita—an ancient Sanskrit text on medicine and surgery (1). These chapters describe nasal reconstruction using a local forehead flap. With advancements in understanding blood supply, numerous facial flap techniques have since been developed.

Pathophysiology

Local flaps are primarily used to close skin defects resulting from trauma or the excision of tissue suspected of malignancy.

For more information, visit our chapter on Excision of Facial Tumors