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Flaps 8 a b d e flaps can be classified according to

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Flaps8. A, B, D, EFlaps can be classified according to the types of blood supply and, in contrast to grafts, introducetheir own blood supply to the recipient area. Flaps can thus be used to reconstruct areas with no,or poor, vascularity. For a random flap, the maximum safe breadth:length ratio is 1:1.5; extendingmore can be done if the extra portion is ‘delayed’ or temporarily raised and replaced for a fewweeks before the whole flap and delayed portion are used in the reconstruction. When the mainvascular supply is confidently known, a longer flap can also be used at a greater distance. This isan example of an axial pattern flap such as the groin flap.9. C, EA random flap cannot be islanded because the blood supply is not known precisely; this is notthe case for an axial pattern flap, which can be islanded. Inclusion of underlying muscle or fasciawith a skin flap increases the flap blood supply if perforators are included. In the design of atransposition flap, it is important to take note of the pivot point as this determines the length ofthe flap to be used. This point is situated at the base of the flap on the side furthest away from thedefect to be covered. The length of this type of flap will be longer than the length of the defect.Usually the donor defect will have to be grafted in part, though in some cases a direct closure maybe possible if this is in a very lax area of skin.10. A, C, EZ-plasties are triangular transposition flaps which are useful in lengthening narrow, not broad,contracture bands. For tip-of-the-nose defects of about 1 cm in diameter, a bilobed flap is agood alternative to a retroauricular full-thickness graft. The rhomboid flap is not a flap for use infingertips but can be in the temple or back. Rotation flaps are mostly used in moderately sizedscalp defects or in the buttocks.11. A, B, DBurrow’s triangles do not play any part in the design or use of bipedicle flaps. Multiple Y to Vflaps are useful in treating burn scars over flexure creases, and V to Y flaps are useful in repair offingertip defects. A good cosmetic result in random flaps can be obtained when attention in design
TRAUMA210is made to the lines of election in the located area. The cosmetic result of a flap is better than agraft because it is thicker, has a better blood supply and retains colour and texture better.12. C, D, EMyocutaneous and fasciocutaneous flaps have very reliable blood supply, and complexequipment and highly trained surgeons are not required. However, it is important to have agood knowledge of anatomy and blood supply for these flaps. Skin survival depends on theperforators, especially if islanded, but the fascia and muscle can be used as flaps without theoverlying skin.13. A, B, C, DFree flap reconstruction is the best method for composite tissue loss but requires expertise andmicrosurgical instruments. Careful debridement of the area for reconstruction is essential forsuccess but major donor site morbidity when chosen carefully as part of a team management isnot a problem. The operative time for microsurgical procedures is usually longer than for othertypes of reconstruction but depends on the experience of the operator and assistants.

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