Skin Flaps Essay
Classically, a flap has been defined as a “tongue of tissue containing skin and sub cutaneous tissues which carries its own blood supply and remains attached to the body at all times for its nourishment”. However, the evolution of flap surgery in the last five decades has been so rapid that this definition has become not only inaccurate but also highly inadequate. Thus, with the increasing knowledge of cutaneous vascular supply, development of microvascular techniques, increasing refinements in available flaps and rapid description of new flaps, a part of fibula or even omentum with its nutrient vascular pedicle is also now termed a flap. For a flap to survive, it must have a pedicle which remains attached to the body at all times or else is
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separated from the body for a very short while only (may be a few hours) and its vascularity restored by microvascular anastomosis as is done for free flaps. While a skin graft is used to provide for wound closure only, a flap not only covers the wounds which cannot be skin grafted but also used for various reconstructions in orthopedic surgery.
History: Sushrata not only described the skin graft but also is credited with the first use of skin flaps.
He is rightly regarded as the father of Plastic Surgery in the world. Reconstruction of chopped off noses (for theft and adultery) was done using flaps from the forehead and cheeks. The term flap originated in 16th century from the Dutch word ‘flappe’, something that hangs broad and loose, joined only on one side. Tagliacozzi, an Italian surgeon in 16th century, used a laterally based flap from the arm to reconstruct nose. During World War I, Sir Harold Gilles (now known as father of modern Plastic Surgery) from England and other workers like Filatov from Russia and Ganzer from Berlin described the tube flap and this was extensively used to treat War victims. During this period and later, the design of flaps was guided by the principle of length–breadth ratio considered to be 1:1 in most places in the body. Gradually, with increasing knowledge it was recognized by McGregor and Morgan (1973) that some flaps when raised had a named artery contained in them leading to an improved length to breadth ratio and sturdier in their survival. Harii Buncke carried out the first free tissue transfer in humans. Hundreds of workers in the last 50 years have described newer and newer flaps and refinements int heir use
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separated from the body for a very short while only (may be a few hours) and its vascularity restored by microvascular anastomosis as is done for free flaps. While a skin graft is used to provide for wound closure only, a flap not only covers the wounds which cannot be skin grafted but also used for various reconstructions in orthopedic surgery.
History: Sushrata not only described the skin graft but also is credited with the first use of skin flaps.
He is rightly regarded as the father of Plastic Surgery in the world. Reconstruction of chopped off noses (for theft and adultery) was done using flaps from the forehead and cheeks. The term flap originated in 16th century from the Dutch word ‘flappe’, something that hangs broad and loose, joined only on one side. Tagliacozzi, an Italian surgeon in 16th century, used a laterally based flap from the arm to reconstruct nose. During World War I, Sir Harold Gilles (now known as father of modern Plastic Surgery) from England and other workers like Filatov from Russia and Ganzer from Berlin described the tube flap and this was extensively used to treat War victims. During this period and later, the design of flaps was guided by the principle of length–breadth ratio considered to be 1:1 in most places in the body. Gradually, with increasing knowledge it was recognized by McGregor and Morgan (1973) that some flaps when raised had a named artery contained in them leading to an improved length to breadth ratio and sturdier in their survival. Harii Buncke carried out the first free tissue transfer in humans. Hundreds of workers in the last 50 years have described newer and newer flaps and refinements int heir use
and