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Review
. 2023 May;31(2):275-287.
doi: 10.1016/j.fsc.2023.01.006.

Reducing Risks for Local Skin Flap Failure

David B Hom  1 , Benjamin T Ostrander  2
Affiliations
Review

Reducing Risks for Local Skin Flap Failure

David B Hom et al. Facial Plast Surg Clin North Am. 2023 May.

Abstract

Local tissue flaps are a fundamental technique in cutaneous reconstruction. Reducing the risk of flap failure is of critical importance. The intrinsic vascularity of a flap is the most important determinant of success. Good surgical techniques, including flap design, delicate tissue handling, and tension-less closure, help reduce the risk of flap compromise. Determining the etiology of compromise, including arterial, venous, hematologic, or infectious, is the first step in salvaging a failing flap. Common causes include pedicle kinking, hematoma, pressure/tension, systemic patient factors, and poor surgical technique. Swift action to restore perfusion or venous outflow through numerous strategies is required.

Keywords: Facial plastic surgery; Flap salvage; Local flaps; Mohs surgery; Plastic and reconstructive surgery; Reconstruction.

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Conflict of interest statement

DISCLOSURE

The authors have no financial or commercial conflicts of interest to disclose. No funding sources were used to complete this work.

Figures

Fig. 1.
Fig. 1.
Skin contains precapillary sphincters (designated by triangle), which regulates blood perfusion by local stimuli and preshunt sphincters (designated by square) which regulates thermoregulation. (Borrowed with permission from Local Flaps in Head and Neck Reconstruction, Figure 2.1, page 14.)
Fig. 2.
Fig. 2.
Vasculature of facial skin. (Borrowed with permission from Local Flaps in Head and Neck Reconstruction, Figure 26.10, page 700.)
Fig. 3.
Fig. 3.
Overlapping vascular skin regions from multiple perforating vessels that interconnect to maximize skin perfusion. (Borrowed with permission from Local Flaps in Head and Neck Reconstruction, Figure 2.4, page 16.)
Fig. 4.
Fig. 4.
To improve local skin perfusion, increasing skin flap thickness is more beneficial than widening its pedicle. (Borrowed with permission from Local Flaps in Head and Neck Reconstruction, Figure 26.11, page 701.)
Fig. 5.
Fig. 5.
Algorithm for management of an acute failing skin flap.
Fig. 6.
Fig. 6.
(A–C) Example of a patient undergoing leech therapy salvage for venous congestion of a paramedian forehead flap to the left nose.
Fig. 7.
Fig. 7.
Research modalities to try to improve skin flap survival. SOD, superoxide dismutase. (Borrowed with permission from Local Flaps in Head and Neck Reconstruction, Figure 2.11, page 14.)
See this image and copyright information in PMC

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