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Flaps for Facial Reconstruction

Facial flaps can be divided into two types: Axial and Random. An axial flap has a named artery supplying it. The surviving length of an axial flap will remain constant regardless of the width of the flap. A random flap has smaller unnamed vessels and is not as stable. It’s surviving length is in direct proportion to the width. A random flap’s surviving length can be lengthened by “delaying” the flap. To delay a flap, it is elevated but left in position as a bipedicle flap. Two weeks later it is raised as a unipedicle flap and placed into position to close the defect. Interpolation flaps traverse skin in order to reach the defect. If placed over the skin, they will have a pedicle. The pedicle can be divided in 3 to 6 weeks depending upon the type of flap and the condition of the patient. Flaps may be “trained” by occluding the blood supply in the pedicle for progressive lengths of time. This allows for an earlier transection of the pedicle. Continue reading