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Flaps

 

synonyms:

Radial Artery Forearm Flap

  • Can cover nearly any wound in the hand and many in the forearm and elbow.
  • Requires harvest of radial artery(risks acute hand ischemia, cold intolerance), poor donor site cosmesis
  • Performed Allen test documenting sufficient ulnar artery flow.
  • Map course of radial artery with Doppler probe.
  • Measure distance from the radial styloid to the proximal aspect of the defect. This is the distance to the distal edge of the flap outline on the forearm. Draw out the pattern of the flap need proximal to this on the forearm.
  • Incise margins of flap extending over the course of the radial artery distally.
  • Dissect from the ulnar side of the flap down to and through the deep fascia. Once the pedical is freed from the ulnar side, slight traction with reveal the artery and veins which lie in the lateral intermuscular septum between the brachioradialis and flexor carpi radialis.
  • Once flap is raised and artery is clearly visualized begin radial dissection.
  • Dissect pedicle distally.
  • Ligate radial artery/veins proximally and rotate flap into defect.
  • Close secondary skin defect in forearm with split-thickness skin graft. Graft take is improved if any visualized FCR tendon is covered with FPL or FDS muscle belly.
  • Post-Op care: Leave post-op dressing on for 7-10 days provided no signs of infection appear. Immobilize wrist, MP & PIP joint for 3 weeks.

Tibial Wound Coverage

  • Proximal Defect: medial gastocnemius rotation flap
  • Mid Defect: Soleus flap
  • Distal Defect: free vascularized pedicle flap vs sural artery island flap
  • Traumatized tissue should not be used for flap coverage. If local flap tissue is traumatized, use free vascularized pedicle flap.

Wound VAC

  • VAC is effective in quickly developing healthy granuation tissues and can be definitive treatment or be used before skin grafting
  • Can be used for distal medial tibial defects, especially in children. (Mooney JF, CORR 2000;376:26), (Caniano DA, J Pediatr Surg 2005;40:128).
  • CPT: 13160, 14000-14350, 15000-15400, 15570-15776 (application of wound vacuum device to open wound or closure requiring local or distant flap coverage and/or skin graft); Codes 97505(<50cm2) or 97606 (>50cm2) may need modifier -59 if performed with during another procedure.

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