Introduction

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

This chapter describes what you should know when preparing, designing and performing facial reconstructive surgery usinglocal skin flaps. 
We present basic knowledge on flap surgery below followed by some specific facial flaps and when to use them. 

Definitions

• Local skin flap: A flap based on skin tissue adjacent to the excision defect. 
  The predominant movement indicates which skin flap is used – i.e., rotation, advancement, transposition, de-epithelized turnover flap.
• Donor site: The site from where the flap is harvested.
• Primary defect/Recipient site: The wound or tissue defect to be closed with the flap.
• Secondary defect: Defect at the donor site of the flap, created when the flap is transferred to the primary defect.
• Primary tissue movement: When the flap is moved into the defect to cover it, it’s referred to as primary tissue movement. This movement also defines the type of local flap: ie. If the flap is rotated into the defect it’s defined as a rotation flap, if the flap is transposed into the defect it is a transposition flap, etc
• Secondary tissue movement: When suturing the flap into place and closing the donor site, the skin surrounding the recipient site is displaced towards the flap inside the defect and the skin surrounding the donor site is displaced towards the scar resulting from closing the donor site, this displacement is the secondary movement surrounding. Acknowledgement of secondary movement is important. Displacement of aesthetic features should be avoided – if the flap is placed poorly, it can cause displacement of eyebrows, ala nasi, lips, etc.

Background

The word flap derives from the Dutch word flappe, which is something that is fastened in one side and hanging loose on the other side

The first documented use of local flaps, as we know it, dates back ancient India in Sushruta Samhita, which is an ancient Sanskrit text on medicine and surgery. In these chapters a nasal reconstruction using a local forehead/frontal flap is described. (1) With the increased understanding of blood supply, dozens of facial local flaps have been developed since then.

Pathophysiology

Flaps are used to close skin defects which most often are the result of either a trauma or excision of tissue with suspicion of malignancy.

Go to the chapter Excision of Facial Tumors to read more.