Skip to main content
SpringerLink
Log in

Flaps in Plastic Surgery

  • Chapter
  • First Online:
Textbook of Plastic and Reconstructive Surgery

Abstract

Flaps are an essential part of reconstruction. Where the defect bed is not able to accommodate grafts or to improve function and esthetics, the flaps are used. Flap is a tissue with its own vascular supply allowing transfer from near or far one place to another. Understanding the classification (6Cs) based on circulation, constituents (composition), conformation (form/shape), contiguity (destination), construction (type of pedicle), and conditioning (preparation) will allow us to apply the flaps accordingly.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
eBook
USD 16.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 119.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 169.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Cormack GCLB. The arterial anatomy of skin flaps 2nd Ed. Chrchill Livingston: Edinburg; 1994.

    Google Scholar 

  2. Hallock GG. The complete classification of flaps. Microsurgery. 2004;24(3):157–61.

    Article  PubMed  Google Scholar 

  3. Taylor GI, Palmer JH. The vascular territories (angiosomes) of the body: experimental study and clinical applications. Br J Plast Surg. 1987;40(2):113–41.

    Article  CAS  PubMed  Google Scholar 

  4. Saint-Cyr M, Wong C, Schaverien M, Mojallal A, Rohrich RJ. The perforasome theory: vascular anatomy and clinical implications. Plast Reconstr Surg. 2009;124(5):1529–44.

    Article  CAS  PubMed  Google Scholar 

  5. Hong JP. Flap classification and application. In: Neligan PC, editor. Plastic Surgery. 1. 4th ed. London: Elsevier; 2018. p. 366–433.

    Google Scholar 

  6. Mathes SJ, Nahai F. Classification of the vascular anatomy of muscles: experimental and clinical correlation. Plast Reconstr Surg. 1981;67(2):177–87.

    Article  CAS  PubMed  Google Scholar 

  7. Cormack GC, Lamberty BG. A classification of fascio-cutaneous flaps according to their patterns of vascularisation. Br J Plast Surg. 1984;37(1):80–7.

    Article  CAS  PubMed  Google Scholar 

  8. Mathes SJNF. Reconstructive surgery: principles, anatomy & technique. New York: Churchill Livingstone; 1997.

    Google Scholar 

  9. Koshima I, Soeda S. Inferior epigastric artery skin flaps without rectus abdominis muscle. Br J Plast Surg. 1989;42(6):645–8.

    Article  CAS  PubMed  Google Scholar 

  10. Hallock GG. Direct and indirect perforator flaps: the history and the controversy. Plast Reconstr Surg. 2003;111(2):855–65. quiz 66

    Article  PubMed  Google Scholar 

  11. Allen RJ, Treece P. Deep inferior epigastric perforator flap for breast reconstruction. Ann Plast Surg. 1994;32(1):32–8.

    Article  CAS  PubMed  Google Scholar 

  12. Blondeel PN. One hundred free DIEP flap breast reconstructions: a personal experience. Br J Plast Surg. 1999;52(2):104–11.

    Article  CAS  PubMed  Google Scholar 

  13. Mardini S, Tsai FC, Wei FC. The thigh as a model for free style free flaps. Clin Plast Surg. 2003;30(3):473–80.

    Article  PubMed  Google Scholar 

  14. Wallace CG, Kao HK, Jeng SF, Wei FC. Free-style flaps: a further step forward for perforator flap surgery. Plast Reconstr Surg. 2009;124(6 Suppl):e419–26.

    Article  CAS  PubMed  Google Scholar 

  15. Hong JP. The use of supermicrosurgery in lower extremity reconstruction: the next step in evolution. Plast Reconstr Surg. 2009;123(1):230–5.

    Article  CAS  PubMed  Google Scholar 

  16. Koshima I, Yamamoto T, Narushima M, Mihara M, Iida T. Perforator flaps and supermicrosurgery. Clin Plast Surg. 2010;37(4):683–9. vii-iii

    Article  PubMed  Google Scholar 

  17. Hong JP, Koshima I. Using perforators as recipient vessels (supermicrosurgery) for free flap reconstruction of the knee region. Ann Plast Surg. 2010;64(3):291–3.

    Article  CAS  PubMed  Google Scholar 

  18. Hyakusoku H, Ogawa R, Oki K, Ishii N. The perforator pedicled propeller (PPP) flap method: report of two cases. J Nippon Med School = Nippon Ika Daigaku zasshi. 2007;74(5):367–71.

    Article  Google Scholar 

  19. Pignatti M, Ogawa R, Hallock GG, Mateev M, Georgescu AV, Balakrishnan G, et al. The "Tokyo" consensus on propeller flaps. Plast Reconstr Surg. 2011;127(2):716–22.

    Article  CAS  PubMed  Google Scholar 

  20. McCarthy JG, Cutting CB, Shaw WW. Vascularized calvarial flaps. Clin Plast Surg. 1987;14(1):37–47.

    Article  CAS  PubMed  Google Scholar 

  21. Casanova R, Cavalcante D, Grotting JC, Vasconez LO, Psillakis JM. Anatomic basis for vascularized outer-table calvarial bone flaps. Plast Reconstr Surg. 1986;78(3):300–8.

    Article  CAS  PubMed  Google Scholar 

  22. Cutting CB, McCarthy JG, Berenstein A. Blood supply of the upper craniofacial skeleton: the search for composite calvarial bone flaps. Plast Reconstr Surg. 1984;74(5):603–10.

    Article  CAS  PubMed  Google Scholar 

  23. Lee HB, Hong JP, Kim KT, Chung YK, Tark KC, Bong JP. Orbital floor and infraorbital rim reconstruction after total maxillectomy using a vascularized calvarial bone flap. Plast Reconstr Surg. 1999;104(3):646–53.

    Article  CAS  PubMed  Google Scholar 

  24. Sakai K, Doi K, Kawai S. Free vascularized thin corticoperiosteal graft. Plast Reconstr Surg. 1991;87(2):290–8.

    Article  CAS  PubMed  Google Scholar 

  25. Bostwick J, Briedis J, Jurkiewicz MJ. The reverse flow temporal artery island flap. Clin Plast Surg. 1976;3(3):441–5.

    Article  CAS  PubMed  Google Scholar 

  26. Matthews RN, Fatah F, Davies DM, Eyre J, Hodge RA, Walsh-Waring GP. Experience with the radial forearm flap in 14 cases. Scand J Plast Reconstr Surg. 1984;18(3):303–10.

    CAS  PubMed  Google Scholar 

  27. Almeida MF, da Costa PR, Okawa RY. Reverse-flow island sural flap. Plast Reconstr Surg. 2002;109(2):583–91.

    Article  PubMed  Google Scholar 

  28. Semple JL. Retrograde microvascular augmentation (turbocharging) of a single-pedicle TRAM flap through a deep inferior epigastric arterial and venous loop. Plast Reconstr Surg. 1994;93(1):109–17.

    Article  CAS  PubMed  Google Scholar 

  29. Yamamoto Y, Nohira K, Shintomi Y, Sugihara T, Ohura T. "Turbo charging" the vertical rectus abdominis myocutaneous (turbo-VRAM) flap for reconstruction of extensive chest wall defects. Br J Plast Surg. 1994;47(2):103–7.

    Article  CAS  PubMed  Google Scholar 

  30. Nakayama Y, Soeda S, Kasai Y. Flaps nourished by arterial inflow through the venous system: an experimental investigation. Plast Reconstr Surg. 1981;67(3):328–34.

    Article  CAS  PubMed  Google Scholar 

  31. Myers MB, Cherry G. Mechanism of the delay phenomenon. Plast Reconstr Surg. 1969;44(1):52–7.

    Article  CAS  PubMed  Google Scholar 

  32. Abbase EA, Shenaq SM, Spira M. el-Falaky MH. Prefabricated flaps: experimental and clinical review. Plast Reconstr Surg. 1995;96(5):1218–25.

    Article  CAS  PubMed  Google Scholar 

  33. Morris SF, Taylor GI. The time sequence of the delay phenomenon: when is a surgical delay effective? An experimental study. Plast Reconstr Surg. 1995;95(3):526–33.

    Article  CAS  PubMed  Google Scholar 

  34. Neumann CG. The expansion of an area of skin by progressive distention of a subcutaneous balloon; use of the method for securing skin for subtotal reconstruction of the ear. Plast Reconstr Surg (1946). 1957;19(2):124–30.

    Article  CAS  Google Scholar 

  35. Kenney JG, DiMercurio S, Angel M. Tissue-expanded radial forearm free flap in neck burn contracture. J Burn Care Rehabil. 1990;11(5):443–5.

    Article  CAS  PubMed  Google Scholar 

  36. Igawa HH, Minakawa HM, Sugihara T, Homma K. Cheek reconstruction with an expanded prefabricated musculocutaneous free flap: case report. Br J Plast Surg. 1995;48(8):569–71.

    Article  CAS  PubMed  Google Scholar 

  37. Pu LL, Wang C. Future Perspectives of Pre-expanded Perforator Flaps. Clin Plast Surg. 2017;44(1):179–83.

    Article  PubMed  Google Scholar 

  38. Guo L, Pribaz JJ. Clinical flap prefabrication. Plast Reconstr Surg. 2009;124(6 Suppl):e340–50.

    Article  CAS  PubMed  Google Scholar 

  39. Pribaz JJ, Maitz PK, Fine NA. Flap prefabrication using the "vascular crane" principle: an experimental study and clinical application. Br J Plast Surg. 1994;47(4):250–6.

    Article  CAS  PubMed  Google Scholar 

  40. Hong JP, Kim EK. Sole reconstruction using anterolateral thigh perforator free flaps. Plast Reconstr Surg. 2007;119(1):186–93.

    Article  CAS  PubMed  Google Scholar 

  41. Hou CL, Tai YH. Transfer of upper pectoralis major flap for functional reconstruction of deltoid muscle. Chin Med J. 1991;104(9):753–7.

    CAS  PubMed  Google Scholar 

  42. Venkatramani H, Bhardwaj P, Sabapathy SR. Role of free functioning muscle transfer in improving the functional outcomes following replantation of crush avulsion amputations of the forearm. Injury. 2019;50(Suppl. 5):S105–S10.

    Article  PubMed  Google Scholar 

  43. Ueda K, Oba S, Nakai K, Okada M, Kurokawa N, Nuri T. Functional reconstruction of the upper and lower lips and commissure with a forearm flap combined with a free gracilis muscle transfer. J Plast Reconstr Aesthet Surg. 2009;62(10):e337–40.

    Article  CAS  PubMed  Google Scholar 

  44. Hallock GG. Simplified nomenclature for compound flaps. Plast Reconstr Surg. 2000;105(4):1465–70. quiz 71-2

    CAS  PubMed  Google Scholar 

  45. Hallock GG. Further clarification of the nomenclature for compound flaps. Plastic and reconstructive surgery. 2006;117(7):151e-60e.

    Google Scholar 

  46. Hallock GG. Simultaneous transposition of anterior thigh muscle and fascia flaps: an introduction to the chimera flap principle. Ann Plast Surg. 1991;27(2):126–31.

    Article  CAS  PubMed  Google Scholar 

  47. Belousov AE, Kishemasov SD, Kochish AY, Pinchuk VD. A new classification of vascularized flaps in plastic and reconstructive surgery. Ann Plastic Surg. 1993, 31(1):47–52. discussion−3

    Google Scholar 

  48. Gottlieb LJ, Krieger LM. From the reconstructive ladder to the reconstructive elevator. Plast Reconstr Surg. 1994;93(7):1503–4.

    Article  CAS  PubMed  Google Scholar 

  49. Pluvy I, Panouilleres M, Garrido I, Pauchot J, Saboye J, Chavoin JP, et al. Smoking and plastic surgery, part II. Clinical implications: a systematic review with meta-analysis. Annales de chirurgie plastique et esthetique. 2015;60(1):e15–49.

    Article  CAS  PubMed  Google Scholar 

  50. Fischer JP, Nelson JA, Sieber B, Cleveland E, Kovach SJ, Wu LC, et al. Free tissue transfer in the obese patient: an outcome and cost analysis in 1258 consecutive abdominally based reconstructions. Plast Reconstruct Surg. 2013;131(5):681e–92e.

    Article  CAS  Google Scholar 

  51. Suominen S, Asko-Seljavaara S. Free flap failures. Microsurgery. 1995;16(6):396–9.

    Article  CAS  PubMed  Google Scholar 

  52. Davison SP, Kessler CM, Al-Attar A. Microvascular free flap failure caused by unrecognized hypercoagulability. Plast Reconstr Surg. 2009;124(2):490–5.

    Article  CAS  PubMed  Google Scholar 

  53. Khouri RK, Cooley BC, Kunselman AR, Landis JR, Yeramian P, Ingram D, et al. A prospective study of microvascular free-flap surgery and outcome. Plast Reconstr Surg. 1998;102(3):711–21.

    Article  CAS  PubMed  Google Scholar 

  54. Endara M, Masden D, Goldstein J, Gondek S, Steinberg J, Attinger C. The role of chronic and perioperative glucose management in high-risk surgical closures: a case for tighter glycemic control. Plast Reconstr Surg. 2013;132(4):996–1004.

    Article  CAS  PubMed  Google Scholar 

  55. Moran SL, Salgado CJ, Serletti JM. Free tissue transfer in patients with renal disease. Plast Reconstr Surg. 2004;113(7):2006–11.

    Article  PubMed  Google Scholar 

  56. Moran SL, Illig KA, Green RM, Serletti JM. Free-tissue transfer in patients with peripheral vascular disease: a 10-year experience. Plast Reconstr Surg. 2002;109(3):999–1006.

    Article  PubMed  Google Scholar 

  57. Chen CL, Shore AD, Johns R, Clark JM, Manahan M, Makary MA. The impact of obesity on breast surgery complications. Plast Reconstruct Surg. 2011;128(5):395e–402e.

    Article  Google Scholar 

  58. Roehl KR, Mahabir RC. A practical guide to free tissue transfer. Plast Reconstruct Surg. 2013;132(1):147e–58e.

    Article  CAS  Google Scholar 

  59. Cho MJ, Kwon JG, Pak CJ, Suh HP, Hong JP. The role of Duplex ultrasound in microsurgical reconstruction: review and technical considerations. J Reconstr Microsurg. 2020;36(7):514–21.

    Article  PubMed  Google Scholar 

  60. Kehrer A, Sachanadani NS, da Silva NPB, Lonic D, Heidekrueger P, Taeger CD, et al. Step-by-step guide to ultrasound-based design of alt flaps by the microsurgeon—basic and advanced applications and device settings. J Plast Reconstr Aesthet Surg. 2020;73(6):1081–90.

    Article  PubMed  Google Scholar 

  61. Duymaz A, Karabekmez FE, Vrtiska TJ, Mardini S, Moran SL. Free tissue transfer for lower extremity reconstruction: a study of the role of computed angiography in the planning of free tissue transfer in the posttraumatic setting. Plast Reconstr Surg. 2009;124(2):523–9.

    Article  CAS  PubMed  Google Scholar 

  62. Masia J, Larranaga J, Clavero JA, Vives L, Pons G, Pons JM. The value of the multidetector row computed tomography for the preoperative planning of deep inferior epigastric artery perforator flap: our experience in 162 cases. Ann Plast Surg. 2008;60(1):29–36.

    Article  CAS  PubMed  Google Scholar 

  63. Pratt GF, Rozen WM, Chubb D, Ashton MW, Alonso-Burgos A, Whitaker IS. Preoperative imaging for perforator flaps in reconstructive surgery: a systematic review of the evidence for current techniques. Ann Plast Surg. 2012;69(1):3–9.

    Article  CAS  PubMed  Google Scholar 

  64. Hallock GG. Acoustic Doppler sonography, color duplex ultrasound, and laser Doppler flowmetry as tools for successful autologous breast reconstruction. Clin Plast Surg. 2011;38(2):203–11.

    Article  PubMed  Google Scholar 

  65. Abdelfattah U, Power HA, Song S, Min K, Suh HP, Hong JP. Algorithm for free perforator flap selection in lower extremity reconstruction based on 563 cases. Plast Reconstr Surg. 2019;144(5):1202–13.

    Article  CAS  PubMed  Google Scholar 

  66. Huang SC, Zhnag Y. All roads lead to Rome: the impact of multiple attainment means on motivation. J Pers Soc Psychol. 2013;104(2):236–48.

    Article  PubMed  Google Scholar 

  67. Webb TL, Sheeran P. Mechanisms of implementation intention effects: the role of goal intentions, self-efficacy, and accessibility of plan components. Br J Soc Psychol/Br Psychol Soc. 2008;47(Pt 3):373–95.

    Article  Google Scholar 

  68. Mathes SJ, Feng LJ, Hunt TK. Coverage of the infected wound. Ann Surg. 1983;198(4):420–9.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Asan Medical Center, University of Ulsan, Seoul, South Korea

    Joon Pio Hong & Jin Geun Kwon

Authors
  1. Joon Pio Hong
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Jin Geun Kwon
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Joon Pio Hong .

Editor information

Editors and Affiliations

  1. Plastic and Reconstructive Surgery, University of Bari Aldo Moro, Bari, Italy

    Michele Maruccia

  2. Plastic and Reconstructive Surgery, University of Bari Aldo Moro, Bari, Italy

    Giuseppe Giudice

Rights and permissions

Reprints and permissions

Copyright information

© 2022 The Author(s), under exclusive license to Springer Nature Switzerland AG

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Hong, J.P., Kwon, J.G. (2022). Flaps in Plastic Surgery. In: Maruccia, M., Giudice, G. (eds) Textbook of Plastic and Reconstructive Surgery. Springer, Cham. https://doi.org/10.1007/978-3-030-82335-1_9

Download citation

  • DOI: https://doi.org/10.1007/978-3-030-82335-1_9

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-030-82334-4

  • Online ISBN: 978-3-030-82335-1

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation