Learn how to use these versatile skin flaps to cover large open wounds.
August 5, 2016|
Daniel D. Smeak
dr. Smeak is a professor and chief of surgery at Colorado State University. His research interests include developing and evaluating innovative methods to train students and residents in essential surgical skills, as well as investigating a wide range of soft tissue surgical conditions. He remains active in the soft tissue surgery specialty practice at his institution and enjoys providing interactive continuing education lectures and wet labs to veterinarians around the world.
Read articles written by Daniel D. Smeak
The caudal superficial epigastric (CSE) flap is a very versatile skin flap with an axial pattern that can be used to cover large open wounds.Figure 1) in him:
- Ipsilateral or contralateral mid-to-caudal trunk
- Later limbs (to some extent).
FIGURE 1. Schematic ventral view of a dog showing the margins of the CSE flap (dashed lines); the yellow area indicates the range of skin defect coverage and the arrows highlight the arc of rotation of the flap in different areas of the body (A). Lateral (B) and caudal (C) views, with skin defect coverage highlighted in yellow.
In dogs with larger body length to limb length ratios (such as basset hounds) and cats, this flap can extend to cover wounds as distal as the metatarsal.
each yearNAVC Institutetakes place in Orlando, Florida, and leading experts in selected areas of veterinary medicine provide hands-on, one-on-one continuing education to institute participants in a multi-day "learning by immersion" experience.
ONAVCeToday's Veterinary Practicecame together to presentPractical techniques from the NAVC Institute, which gives our readers an insight into the unique education offered at the Institute through articles published in the journal.
This article reviews session information,Practical techniques in soft tissue surgery, presented at the NAVC Institute 2015.
This extensive swath of skin transfer is due to the long and robust CSE artery, which branches from the external pudendal artery in the caudal part of the inguinal canal; then continues cranially just below the mammary glands along the mammary row (Figure 2).
FIGURE 2. Anatomic course of the CSE vessel along the thoracic spine.Reprinted with permission from Pavletic M.Atlas of Small Animal Wound Care and Reconstructive Surgery,3. udg. Hoboken, NJ: Wiley Blackwell, 2010, p. 383.
When the flap is created, most of the skin in the pectoral chain, once the cranial, medial and lateral aspects of the flap have been released, can be lifted away from the abdominal fascia and effectively transferred to distant skin defects. The donor skin defect can then be closed routinely, similar to closure after a unilateral mastectomy.
Due to the flap's abundant blood supply and thick subcutaneous tissue padding, the flap can be used to cover:
- Deep wounds without granulation bed
- Wounds with exposed bones or tendons
- Areas that require durable, full-thickness skin coverage.
The most common indications for CSE axial pattern flaps are (Figure 3-5):
- Large debilitating injuries to hind leg
- Large skin defects after wide surgical excision of neoplasia.
FIGURE 3. Skin defect due to wide surgical excision of a fibrosarcoma in the left flank area (A) and left pectoral chain CSE flap transferred to cover the defect (B).
FIGURE 4. Large defect due to wide excision of a large scrotal mast cell tumor in a 10-year-old boxer (A). Reconstruction with left ECS flap (B), with Jackson-Pratt drain placed under the flap and donor area. Note that the drain outlet is lateral to the closed donor site.
FIGURE 5. A large deloving wound extending from the medial knee to the tarsus in a mongrel dog that was reconstructed with a left CSE flap. The hock area is visible on the most distal aspect of the flap (bottom of image).
What do you need
- Standard surgical instrument pack
- #10 or #15 scalpel blades
- 3-0 or 4-0 absorbable monofilament suture on conical needle
- 3-0 or 4-0 non-absorbable monofilament suture on cutting needle
- Many laparotomy sponges
Optional but useful:
- Various ham hooks
- Jackson-Pratt Drain Bulb and Multi-Fented Tubing
- Extra small towel clips (8–10)
- DeBakey Atraumatic Thumb Forceps
General preoperative considerations
- Perform a complete physical exam and obtain a minimal database, including a complete blood count and serum biochemistry profile.
- CENTRAL POINT: In patients with skin defects caused by significant trauma, rule out trauma to other organ systems (eg, bladder rupture, diaphragmatic hernia). To donourgent reconstruction of an acute traumatic wound. Focus first on proper early care of open wounds and stabilizing the patient.
- Prior to any major reconstructive effort, contamination in a traumatic wound is limited with appropriate antibiotic therapy, local wound care, and dressings.
for mere informationabout wound care, visittvpjournal.comhe was:
- Moist wound healing: the new standard of care (July/August 2015)
- Useful tips for treating wounds in veterinary patients (November/December 2013)
- Unique Therapies for Severe Wounds (July/August 2011).
Consider skin coverage
- CENTRAL POINT: Prior to surgery, ensure that the axial CSE vessel is healthy along the way by visually inspecting the area. If trauma or skin loss is close to the inguinal ring or pectoral chain and the viability of the vessel is questionable, color Doppler imaging or angiogram studies can help determine whether the axial vessel has been damaged. If there is any doubt as to the viability of the vessel, use the contralateral healthy breast chain for skin transfer.
- Determine the approximate length of skin perfused by the caudal superficial axial vessel (angiosome) by measuring from the superficial inguinal ring to the area midway between the first 2 mammary glands (the most cranial extension of the skin supplied by this vessel) (Figure 1A). This skin length is the same in men and women. In men, however, one or more small branches of the CSE vessel supply the preputial skin. These branches must be carefully ligated to allow complete rotation of the base of the flap in men.
- Measure the distance from the bottom of the flap to the furthest point from the open wound. I prefer to add approx. 20% of the skin flap length needed to cover the defect because a portion of the flap length is lost when the flap is rotated in place and the flap can be expected to shrink slightly. Determine the ability of the flap to cover the defect based on these initial measurements.
- Determine the maximum flap width by measuring from the abdominal midline to the nipple; then extend the measured length laterally to the nipple (Figure 1A).
- If a "paddle" of skin is needed to cover a large round defect wider than the maximum flap width, consider folding the terminal side of the flap into a "U" turn to basically double your effective flap width (Figure 6). To ensure that the planned flap transfer is feasible, add this extra folded skin to the proposed skin flap length measurement.
FIGURE 6. Labrador retriever with left CSE flap; the distal aspect is bent to form an “oar” to reconstruct a large caudal femoral defect after wide excision of a malignant tumor. The yellow dashed arrow shows the folded distal end of the flap.
- Administer general anesthesia and position the patient in a supine or lateral position to allow simultaneous access to the desired donor mammary chain and the skin defect.
- In addition, first-generation cephalosporin antibiotics are administered at induction of anesthesia and then every 90 minutes until the wound is surgically closed.
- Cut and prepare a generous area around the proposed skin defect and the donor skin region. Plan to include a lot of adjacent skin in the aseptically prepared field because once the donor site is closed, surrounding skin will be mobilized into the field. When the skin defect involves the hindlimb, hang and prepare the limb aseptically to facilitate skin transfer and wound closure.
- Aseptically cover the entire field, with ample skin included around the exposed donor and recipient sites.
Recipient wound preparation
1. Use aseptic technique to debride and irrigate the wound if it is not completely covered by healthy granulation tissue. Tissue culture taken from the wound bed, particularly if the wound is considered to be contaminated.
- If the flap is used to reconstruct an open wound, wash the wound bed with an appropriate antiseptic solution and routinely cut and aseptically prepare the surrounding skin.
- If the wound is more chronic and the skin wound edges are partially epithelialized, turn the wound edges and remove thin epithelialized tissue by extending the wound bed margins with a scalpel blade.
2. Open the skin edges of the wound wide by several millimeters to create a free edge to which the flap should be sutured. Cover the prepared recipient wound with moistened laparotomy pads when starting flap preparation (donor skin).
Donor skin preparation
1. Draw the suggested dimensions of the brim with a sterile drawing pen (Figure 7). The medial border is located on the ventral abdominal midline from the pubis to a point between the first and second mammary glands. In male dogs, the medial caudal border includes the skin just lateral to the base of the foreskin.
FIGURE 7. Large skin defect in the medial caudal region of the left thigh of a dog (A). The left limb is pulled upwards, showing the medial femoral defect. Ink lines show proposed skin incision to create CSE flap (B); X is above the groin ring. The surgeon traces the course of the CSE vasculature down the middle of the left thoracic chain.
2. The lateral edge of the flap should be parallel and the same length as the medial edge (midline). Draw the lateral boundary line as far from the nipple line as the measured distance from the midline to the nipple line. Essentially, the width of the flap is twice the measurement from the midline to the nipple line.
3. Taper the lateral border of the skin towards the inguinal ring area, which facilitates closure of the donor defect in the inguinal region after flap transfer.
4. After determining the proper flap length, a line connecting the medial and lateral lines of the skin flap is drawn on the distal aspect of the proposed skin flap. Shape the distal end of the flap with rounded edges to facilitate closure of the cranial aspect of the donor defect without folds.
Incise and undermine the flap
1. Use a scalpel blade to cut the skin along the edge of the lines drawn to outline the flap. As the skin incision tapers caudally into the groin area, do not damage nearby underlying CSE vasculature.
2. Starting at the distal aspect of the flap (the most cranial aspect), gently and neatly detach the subcutaneous tissue directly from the abdominal wall. On the most cranial aspect, expect firm attachment of the subcutaneous tissue to the underlying pectoral muscles. Detachment is easier as the dissection progresses caudally because the subcutaneous tissue is loosely connected to the underlying fascia. Avoid using thumb forceps to grab skin edges; instead, use hooks or digital manipulation to handle and retract the flap (Figure 8).
FIGURE 8. The flap has been undermined and the surgeon uses Metzenbaum scissors to release tissue at the base of the flap. Proposed bridge section (dashed line). The base of the brim is between two X's.
3. Cover donor skin edges and defects with moistened laparotomy pads while peeling off the flap.
4. KEY POINT: As the detachment progresses towards the annular region of the groin, extra care must be taken when directly dissecting the subcutaneous tissue around the base of the flap and the epigastric trunk of the pudendum. Consider leaving the inguinal fat pad (process vaginal) and fat plug intact, provided the underside of the flap can be rotated into place effectively.
Create a bridge incision if needed
1. If the base of the flap does not extend to encompass the skin defect, a bridging incision is required to allow a path for the flap to reach the recipient bed.
2. Make an incision in the skin and subcutaneous tissue directly between the base of the flap and the recipient bed. Determine where the base of the flap best fits within its rotated arc to determine where the bridging incision should be made (Figure 9).
FIGURE 9. Electrotomy is used to create a bridging incision that connects the base of the flap to the defect. The edges of the separated bridge incision are delimited by dashed lines.
3. Make an undercut in the skin adjacent to the bridge incision to allow the width of the base of the tapered skin flap to fit snugly against it.
Transfer the flap to the recipient bed
1. Turn the flap over the wound.CENTRAL POINT: The flap can be stretched slightly to accommodate the wound defect, but it does not allow tension or buckling of the CSE vessel if the flap is rotated 180 degrees or more.
2. Ensure that the distal aspect of the flap is positioned in the most distal area of the open wound. Try different flap positions until you find the best flap location (Figure 10).
FIGURE 10. The location of the flap is adjusted to fit within the defect.
3. Once the best flap position is found, move the affected limb in various directions to ensure the flap is not under tension (especially in normal standing and standing positions).
4. If the open wound is rounded and wide and a "U-turn" of the distal flap is planned to create a "paddle", additional flap maneuvers may be required before closure is initiated (Figure 6).
5. If the flap does not completely cover the open wound, use other reconstructive options for closure.
6. Although many surgeons prefer routine closed suction drainage of these flaps to prevent seroma, I have found that drainage is usuallynonecessary if atraumatic subcutaneous dissection and detachment are performed and hemostasis is careful. If drainage is chosen, ensure that there is a good seal around the edges of the wound during closure. To donoleave the suction drain closed by the valve; instead, leave it to the side of the flap (Figure 4).
Suturing the wound edges
1. KEY POINT: I prefer not to drop or use walking stitches subcutaneously to try to reduce movement and dead space under the flap and inguinal region. These sutures can inadvertently damage the blood supply to the valve.
2. Starting with the most distal aspect of the flap, use widely spaced interrupted hypodermic sutures to secure the flap in its permanent location (Figure 11). Alternatively, some surgeons use small towel clips to help hold the flap edges and the donor defect together during suturing.
FIGURE 11. Simple interrupted hypodermic sutures are placed to distribute tension evenly around the flap and the margins of the defect.
3. Once these sutures have loosely positioned the flap, begin to close the hypodermic layer with 3-0 or 4-0 absorbable monofilament suture material in a continuous pattern. Close the skin with a single interrupted or single continuous pattern (my preference) 3-0 or 4-0 non-absorbable monofilament or skin staples.
4. Keep the donor defect covered with moistened laparotomy pads until the flap hypodermis and defect margins are closed. Trim the donor skin margins if tension occurs during defect closure.
5. Continue closure of the donor defect with hypodermic and skin sutures using the previously mentioned materials (Figure 12).
FIGURE 12. Complete CSE flap at suture removal 14 days after reconstruction; this is the same dog shown in figures 7 to 11.
Once the operation is finished, place an Elizabethan collar on the patient and cover the donor breast region with a stocking or light bandage (at the surgeon's discretion). I prefer not to bandage the flap postoperatively, as dressings often "ride up" in the inguinal region, which can cause discomfort and, more importantly, put pressure on the vasculature of the flap, compromising flap perfusion.
The donor area can be cold packed for several days after surgery, but I prefer to avoid cold compressing the flap area, which can cause vasoconstriction of the subdermal blood supply and compromise the flap.
CENTRAL POINT: Expect the extensive skin incision and detachment to cause significant pain after surgery. Therefore, systemic opioids and non-steroidal anti-inflammatory drugs are administered postoperatively for 24 to 48 hours. Appropriate oral analgesics are given for 5 to 7 days after surgery.
The use of postoperative antibiotics is limited to patients with evidence of wound infection or patients in whom aseptic technique breaks down during the surgical procedure.
Owners are instructed to carefully monitor wounds and seek veterinary care if they notice increased discomfort, inflammation or drainage after surgery. Patients should be strictly limited to walking on a leash and prohibited from climbing stairs, jumping or running until suture removal 14 days after surgery. The patient can then gradually increase the activity.
Seromas, hematomas, and disc wounds are possible postoperative complications seen after extensive reconstructive surgery, as described in this article (Figure 13).
- When a seroma or hematoma forms, do not invade the wound; Consider cage rest and warm wound packing starting several days after surgery.
- Consider early reconstruction of minor injuries at the wound edge if there is no evidence of infection.
- The distal aspect of the flap is more susceptible to avascular necrosis and dehiscence. Debride necrotic tissue and keep the wound open until healthy granulation tissue forms. The surgeon may decide to leave the wound open for secondary intention healing or to attempt a secondary closure.
FIGURE 13. Patient with seroma under a right CSE flap used to reconstruct a defect over the cranial bone and proximal lateral tibia.
If performed correctly, CSE axial pattern flaps have a low risk of flap necrosis (< 10%) and infection. Minor complications, such as seroma, partial incision failure, flap swelling, and bruising, are generally amenable to conservative treatment and do not affect the long-term prognosis.
CSE = caudal superficial epigastric
- Aper RL, Smeak DD. Clinical evaluation of superficial epigastric caudal axial patter reconstruction of skin defects in 10 dogs (1989-2001).GUL2005; 41(3):185-192.
- Campbell BG. Skill Lab: How to Perform a Caudal Superficial Epigastric Flap. Available at veterináriamedicine.dvm360.com/skills-laboratory-how-perform-caudal-superficial-epigastric-flap?rel=canonical.
- Pavletic MM.Atlas of Small Animal Wound Care and Reconstructive Surgery, 3rd ed. Ames, IA: Wiley-Blackwell. 357-4
- Pavletic MM. Caudal superficial epigastric arterial pedicle engraftment.Veterinary Surgeon1980; 9(3):103-107.
What is the caudal superficial epigastric flap? ›
The caudal superficial epigastric (CSE) flap is a highly versatile axial pattern skin flap that can be used to cover large open wounds (Figure 1) on the: Ipsilateral or contralateral mid to caudal trunk. Perineum. Hindlimbs (to some extent).What is the caudal superficial epigastric vein? ›
The caudal superficial epigastric artery is the direct cutaneous artery for the caudal superficial epigastric axial pattern flap. The direct cutaneous artery and vein extend along the length of the flap for a variable distance and the terminal branches supply the subdermal, cutaneous, and subpapillary plexuses.What is cranial superficial epigastric axial pattern flap? ›
The cranial superficial epigastric axial pattern flaps have potential application for closure of skin defects within their arc of rotation and may be particularly useful for closure of large defects on the ventral aspect of the thorax.What type of wound closure is a skin flap veterinary? ›
A transposition skin flap is a segment of skin and subcutaneous tissue or panniculus muscle (e.g. cutaneous trunci) that is lifted and has its orientation shifted as it is placed onto a wound. Thus, the flap is transposed to close the wound.What is the difference between superficial and inferior epigastric? ›
The superficial epigastric arteries course from the femoral artery and ligament toward the umbilicus, anterior to the rectus sheath. The inferior epigastric arteries lie behind the rectus muscles, roughly in the middle of the rectus sheath.What is the difference between superficial epigastric and superior epigastric? ›
The superficial epigastric artery supplies the superficial tissue of the abdominal wall; the superior and inferior epigastric arteries make an anastomosis with each other and supply the muscles of the abdominal wall.What is the function of the superficial epigastric vein? ›
The superficial inguinal veins drain into the femoral vein and drain the skin of the lower part of the abdomen. The superficial epigastric vein runs upward and medially and drains the skin up to the umbilicus.What is another name for superficial epigastric vein? ›
The great saphenous vein and its tributaries.Where is the superficial epigastric artery found in the body? ›
The superficial epigastric artery is a branch of the femoral artery, originating about 1 centimeter below the inguinal ligament. It then courses superiorly, traverses the cribriform fascia and passes anterior to the middle segment of the inguinal ligament.How do you classify flap surgery? ›
Multiple classifications have been described, but, in general, flaps for reconstruction are classified based upon the type of blood supply (ie, random, axial), proximity of the donor tissue to the recipient (ie, local, regional, distant), and tissue composition (eg, musculocutaneous, fasciocutaneous) .
What causes flap necrosis? ›
Skin flap necrosis is caused by a lack of blood and oxygen to the tissue and may be evident by the 2nd to 4th day following surgery. It often shows as an area of darkness or blood-stained blister on the leading edge of the flap. A doctor or wound care specialist evaluation is required to identify it.What is flap thinning? ›
Flap thinning is a procedure for making a thick flap thinner.What are the three stages of skin flap healing? ›
There are three stages of skin graft healing: imbibition, inosculation, and revascularization.Do you need stitches for flap of skin? ›
Lacerations, punctures, and incisions are all suturable wounds (they can be stitched). Avulsions that still have a flap of skin attached may also be suturable. Complete avulsions and abrasions cannot be stitched, but you still may need a doctor to treat the wound if it's serious enough.What are the 4 methods of wound closure? ›
Wounds can be closed primarily in the emergency department (ED) by the placement of sutures, surgical staples, skin closure tapes, and adhesives.What is superficial inferior epigastric artery flap? ›
The superficial inferior epigastric artery (SIEA) flap uses a medially located vein – the superficial epigastric artery – and, rarely, its associated venea to reliably perfuse the ipsilateral hemiabdominal wall skin and fat. The anterior abdominal wall fascia is left intact in all cases.What does epigastric mean in medical terms? ›
(EH-pih-GAS-trik) Having to do with the upper middle area of the abdomen.Where does superficial epigastric vein drain? ›
The superficial epigastric vein drains into the great saphenous vein at the saphenous opening of the fascia lata of the proximal upper thigh.Does epigastric mean behind the stomach? ›
Epigastric pain is a name for pain or discomfort right below your ribs in the area of your upper abdomen. It often happens alongside other common symptoms of your digestive system. These symptoms can include heartburn, bloating, and gas. Epigastric pain isn't always cause for concern.Is epigastric pain upper or lower? ›
Epigastric pain is pain that is localized to the region of the upper abdomen immediately below the ribs. Often, those who experience this type of pain feel it during or right after eating or if they lie down too soon after eating. It is a common symptom of gastroesophageal reflux disease (GERD) or heartburn.
Is epigastric pain above the stomach? ›
Epigastric pain is pain in the upper abdomen. It can be a sign of disease. Common causes include: Acid reflux (stomach acid flowing up into the esophagus)Why are superficial veins important? ›
The superficial vessels are responsible for carrying the blood from the tissues closer to the skin's surface to the deep veins. Later on, the deep veins push the blood back toward the heart.What does the epigastric vein drain into? ›
The superior epigastric veins drain into the internal thoracic vein.What do superior epigastric vessels do? ›
In human anatomy, the superior epigastric artery is a terminal branch of the internal thoracic artery that provides arterial supply to the abdominal wall, and upper rectus abdominis muscle. It enters the rectus sheath to descend upon the inner surface of the rectus abdominis muscle.What does the superficial epigastric artery supply? ›
The superficial epigastric artery (TA: arteria epigastrica superficialis) is a small cutaneous branch of the common femoral artery which contributes to the arterial supply of the anterior abdominal wall below the umbilicus.What is the main vein in your stomach called? ›
The hepatic portal vein is a vein that receives all the venous blood from the stomach, small and large intestines, pancreas and spleen.What is another name for epigastric? ›
synonyms for epigastrium
On this page you'll find 11 synonyms, antonyms, and words related to epigastrium, such as: abdomen, belly, bulge, fat, gut, and potbelly.
|Origin||Internal thoracic artery|
|Branches||Muscular branches to rectus abdominis and diaphragm, cutaneous branch to the skin of anterior abdominal wall|
|Supply||Rectus abdominis muscle and its overlying skin, anterior muscular slips of diaphragm|
Your inferior epigastric artery supplies blood to your abdominal muscles. It branches from your external iliac artery near your groin. It has many of its own branches that feed muscles and tissues in your abdomen and pelvis.What is the most common flap surgery? ›
TRAM (transverse rectus abdominis muscle) flap is one of the most common types of flap surgery. The surgeon takes muscle and tissue from the lower belly and moves it to the chest area.
How long does flap surgery last? ›
DIEP flap or tissue flap breast reconstruction can be performed immediately following a mastectomy or as delayed reconstruction. Patients will be given general anesthesia before surgery. The surgery takes four to six hours, but it can take longer if performed along with a mastectomy.Who needs flap surgery? ›
The flap procedure is necessary when severe gum disease (periodontitis) has damaged the bones that support your teeth.What are the symptoms of a flap failure? ›
A clinical diagnosis of venous insufficiency of a flap is made, which showed the following findings: purplish color, shortening refill time (<3 seconds), dark blood at pin prick, venous bleeding on the flap edges, and increased edema.What are the first signs of necrosis? ›
The infection often spreads very quickly. Early symptoms of necrotizing fasciitis can include: A red, warm, or swollen area of skin that spreads quickly. Severe pain, including pain beyond the area of the skin that is red, warm, or swollen.What are the signs of skin flap failure? ›
WHAT DOES A FAILED SKIN GRAFT LOOK LIKE? Compromised or failed skin grafts are characterized by continuous pain, numbness, fever, discoloration, redness, swelling, or a breakdown of tissue. The most obvious sign of an unhealthy skin graft is darkening skin that lacks the pink appearance of healthy skin.What is flap complications? ›
What are flap complications? Flap complications occur during the healing process and essentially mean errors in the healing of this epithelial flap. This could mean an uneven corneal surface or just poor healing of the corneal flap in general.What is the reason for flap surgery? ›
The primary purpose of flap surgery is to remove or decrease the pocket. A flap-like incision in the gum tissue is created to access the pocket. This makes it possible to remove the diseased tissue from the pocket and adequately clean the root surfaces of the teeth, which aids in the removal of toxic plaque and tartar.What happens during flap surgery? ›
Flap surgery involves the transfer of a living piece of tissue from one part of the body to another, along with the blood vessels that keep it alive. It may be used for a variety of reasons, including breast reconstruction, open fractures, large wounds, and, in rare cases, for improving a cleft lip and palate.How long does it take a flap of skin to reattach? ›
Keeping the site moist with the above procedures will hasten healing and provide you with the nicest scar possible. Do not wear make up over the incisions or flap until the sutures are removed (or have dissolved), and a thin layer of new skin covers the area. This usually takes 7 to 10 days.Can a skin flap heal on its own? ›
How does a skin flap heal? A skin flap heals like a normal wound does. The flap is kept alive by the blood supplied by its own blood vessels. Over time, these blood vessels may grow and supply more blood to the area.
Can a skin flap reattach? ›
If there is still a skin flap attached to the wound, and the flap is healthy, your doctor may be able to reattach the skin into its original place. In order to do this, the skin flap must still have good blood flow. After the skin is stitched back into place, tubes will likely need to be used to remove excess fluid.What are the disadvantages of skin flap? ›
The main disadvantage of a skin flap is that extra incisions are required which are sometimes quite large. Every effort is made to camouflage these incisions by placing them in the natural skin lines. Flaps may become infected or bleed like any other skin procedure. Occasionally the skin flap may breakdown.What is the success rate of skin flap surgery? ›
In total, 108 free tissue transfers were performed; 23% were fasciocutaneous free flaps, 69% musculocutaneous and 8% osteoseptocutaneous. The overall flap success rate was 92.6%. Over a third of patients (34.3%) had flap-related complications ranging from minor wound dehiscence to total flap loss.What are the complications of skin flap surgery? ›
Reported complications associated with skin flaps include infection, seroma/hematoma, skin edge dehiscence, self-trauma/mutilation, and distal flap necrosis. Improper immobilization, infection, seroma/hematoma, and poorly vascularized wound bed are the common causes of free skin graft failure.What is the golden hour of wound closure? ›
However, the exact “golden period” was never defined. In the 1970s, the limit of 6 hours for primary closure was extended to 12 hours for clean wounds (10). In many surgical textbooks, the “golden period” ranges from 3 to 24 hours, without any evidence to support it (11-13).What is the golden period for wound closure? ›
The first 6-8 hours after a wound is called the "golden period" because clinical studies show that there are less than 105 organisms/gram tissue within that time and so the wound can be closed safely.Can you leave stitches in longer than 10 days? ›
These are the usual time periods: stitches on your head – you'll need to return after 3 to 5 days. stitches over joints, such as your knees or elbows – you'll need to return after 10 to 14 days. stitches on other parts of your body – you'll need to return after 7 to 10 days.Where are the superficial epigastric vessels? ›
The superficial epigastric artery is a branch of the femoral artery, originating about 1 centimeter below the inguinal ligament. It then courses superiorly, traverses the cribriform fascia and passes anterior to the middle segment of the inguinal ligament.What are the flaps in the stomach? ›
There are two main types of abdominal flaps: a free transverse rectus abdominis myocutaneous (TRAM) flap and a newer type called a free deep inferior epigastric perforator (DIEP) flap. These flaps are called free flaps because the flap is cut completely away from the blood supply in the abdomen.What is the superficial epigastric a branch of? ›
The superficial epigastric artery (TA: arteria epigastrica superficialis) is a small cutaneous branch of the common femoral artery which contributes to the arterial supply of the anterior abdominal wall below the umbilicus.
What does the superficial epigastric vein do? ›
The superficial inguinal veins drain into the femoral vein and drain the skin of the lower part of the abdomen. The superficial epigastric vein runs upward and medially and drains the skin up to the umbilicus.Where is the superficial inferior epigastric artery? ›
Anatomy. The superficial inferior epigastric artery arises from the femoral artery, below the inguinal ligament. The vessel travels in the subcutaneous fat of the inferior abdomen and spreads out to supply the hemi-abdomen.What hernia is inferior to epigastric vessels? ›
Direct inguinal hernias exit medial and anterior to the course of the inferior epigastric vessels, then are directed inferior to the inferior epigastric vessels as the hernia sac protrudes. They represent a bulge in the anterior abdominal wall lateral to the rectus muscle.What do epigastric vessels do? ›
Your inferior epigastric artery gives rise to several branches. These branches supply blood to muscles and tissues in your belly and pelvis. So, your inferior epigastric artery and its branches play an important role in supporting blood flow throughout your body.How do you get rid of a stomach flap? ›
It's impossible to spot treat an apron belly. The only ways to reduce one are through overall weight reduction and surgical/non-surgical options.Can you lose belly flap? ›
You can reduce or remove your apron belly
The only ways to reduce or remove your apron belly are through overall weight reduction and surgical and non-surgical options that include the following: Laser to remove some belly fat.
To lose stomach overhang you have to burn fat cells in both the fat you can see directly under the skin and also the more dangerous fat that you can't see that surrounds your organs. Cardio such as swimming, aerobics, running or dancing will burn this excess fat store.What organs are in the epigastric region? ›
The epigastric region contains the duodenum, a portion of the liver, the pancreas and a portion of the stomach, while the umbilical quadrant contains the transverse colon and the duodenum.What body regions are epigastric? ›
Epigastric. The epigastric (above stomach) region contains the majority of the stomach, part of the liver, part of the pancreas, part of the duodenum, part of the spleen, and the adrenal glands.