Chapter 22 - Famona Site

C. Basic concepts:1. Based on arterial supply.2. A flap is an island. The width of the base of the flap is unimportant beyond thenecessity to contain a vascular pedicle.3. Tubing of flap is useful if only the distal portion is used in the transfer (preventsinfection and granulation).4. Delay of flaps:a. Decision based on need.b. Will increase chances of survival.delay.c. Effects dermal and subdermal vessel hypertrophy and hyperplasia with a 7-14 dayd. Allows greater length of flap for use.5. Transfer of blood supply from graft site distal, useful end of flap - approximately14 days.6. Flaps die of congestion, rarely from anemia.7. The patient's blood pressure, hemoglobin, and hematocrit are vital for flap survival.8. A clean, well-vascularized bed required for transfer.9. No tension at suture line.10. No twisting of pedicle or pressure on pedicle allowed or impairment of flapcirculation will occur.Advantages and Disadvantages of the Flap1. Capable of carrying tissues other than skin.2. Carries its own blood supply, therefore, more likely to "take".3. Less tendency to discolor, more resistant, more elastic, more movable, and lesslikely to contract. Although a 25% leeway should be kept in mind in the planning of a pedicleflap.4. More adaptable to weight bearing.5. Capable of bridging a defect.4