Subcutaneous Pedicle Skin Flaps



Subcutaneous Pedicle Skin Flaps


J. N. BARRON

M. N. SAAD





The subcutaneous pedicle skin flap consists of a skin paddle and a pedicle containing only subcutaneous tissue (1, 2, 3). Three donor sites are available for nasal reconstruction: (1) the nose itself, (2) the nasolabial area, and (3) the frontoglabellar region.

In the open technique, the donor and recipient sites are joined by an incision, and the flap is transferred under direct vision. In the closed technique, the skin lying between the
donor and recipient sites is undermined, and the flap is transferred through a tunnel.




ANATOMY

It is not necessary to include an anatomically designated axial vascular system in the pedicle, although, if available, this is an advantage. Many subcutaneous pedicle flaps rely on a random capillary circulation, and because this is a low-pressure flow, it demands an ultra-atraumatic technique for dissection. We believe that the unilateral subcuticular suture disturbs the flap margin much less than ordinary interrupted sutures.






FIGURE 44.1 A,B: Design of the flap showing skin paddle and subcutaneous pedicle (closed technique). Note that the circulation is random pattern, although axial vessels may be included in the pedicle in certain cases.

A direct vascular supply can be included with some subcutaneous pedicle skin flaps (4). Superiorly based nasolabial flaps derive their blood supply from the supraorbital and supratrochlear anastomoses, and the inferiorly based flap is nourished by the terminal branches of the facial artery or the superior labial vessels. Flaps from the frontoglabellar region can include blood supply from the supratrochlear vessels.


FLAP DESIGN AND DIMENSIONS

The function of the pedicle is to transmit blood, lymph, and nerve supply to the flap. Thus a good pedicle design is essential (Fig. 44.1). The pedicle should be long enough to allow the flap proper to reach the recipient site without the slightest tension.

The pedicle also should contain sufficient vascular elements to sustain the viability of the flap and, if possible, provide adequate sensation. The design should be such that kinking is avoided, and whenever possible, gravity should help venous and lymphatic drainage.

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Jun 26, 2016 | Posted by in General Surgery | Comments Off on Subcutaneous Pedicle Skin Flaps
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