Abstract
When simple primary closure is not ideal, a tissue-movement procedure, such as a flap, should be considered. The planning and execution of a flap repair following Mohs surgery vary from case to case. A skilled surgeon evaluates the risks and benefits of various options in each individual patient and anticipates potential complications. The elements to successful flap execution include proper patient selection and preparation, comprehension of risks and necessary precautions, use of sterile or clean technique, informed procedure design and meticulous suture technique, as well as good postoperative wound care and patient education. Flaps are commonly classified according to their primary movement – advancement flaps, rotation flaps, transposition flaps, and interpolation flaps – and each has its benefits and drawbacks. Meticulous postoperative wound care is necessary to ensure an optimal outcome. Patients should be seen for follow-up to evaluate outcomes and any necessary interventions.
This is a preview of subscription content, log in via an institution to check access.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
References
Berg JW, Appelbaum PS, Lidz CW, Parker LS. Informed consent: legal theory and clinical practice. 2nd ed. New York: Oxford University Press; 2001.
Chang LK, Whitaker DC. The impact of herbal medicines on dermatologic surgery. Dermatol Surg. 2001;278:759–63.
Futoryan T, Grande D. Postoperative wound infection rates in dermatologic surgery. Dermatol Surg. 1995;21(6):509–14.
Dixon AJ, Dixon MP, Askew DA, Wilkinson D. Prospective study of wound infections in dermatologic surgery in the absence of prophylactic antibiotics. Dermatol Surg. 2006;32(6):819–26; discussion 826–817.
Milton SH. Pedicled skin-flaps: the fallacy of the length: width ratio. Br J Surg. 1970;57(7):502–8.
Daniel RK, Williams HB. The free transfer of skin flaps by microvascular anastomoses. An experimental study and a reappraisal. Plast Reconstr Surg. 1973;52(1):16–31.
Stell PM. The pig as an experimental model for skin flap behaviour: a reappraisal of previous studies. Br J Plast Surg. 1977;30(1):1–8.
Chilukuri S, Leffell D. Basic principles of flap reconstruction. In: Cook JL, Rohrer TE, Nguyen TH, Mellette JR, editors. Flaps and grafts in dermatologic surgery. London: Elsevier; 2007.
Fazio MJ, Zitelli JA. Flaps. In: Ratz JL, Geronemus RG, Goldman MP, et al., editors. Textbook of dermatologic surgery. Philadelphia: Lippincott-Raven; 1998. p. 225–7.
Heniford BW, Bailin PL, Marsico Jr RE. Field guide to local flaps. Dermatol Clin. 1998;16(1):65–74.
Dzubow LM. Flap dynamics. J Dermatol Surg Oncol. 1991;17(2):116–30.
Antia NH, Buch VI. Chondrocutaneous advancement flap for the marginal defect of the ear. Plast Reconstr Surg. 1967;39(5):472–7.
Mellette Jr JR, Harrington AC. Applications of the crescentic advancement flap. J Dermatol Surg Oncol. 1991;17(5):447–54.
Dzubow LM, Lambert RW. A dorsal nasal advancement flap for off midline defects. J Am Acad Dermatol. 2004;50(3):380–3.
Tomich JM, Wentzell JM, Grande DJ. Subcutaneous island pedicle flaps. Arch Dermatol. 1987;123(4):514–8.
Dzubow LM. The dynamics of flap movement: effect of pivotal restraint on flap rotation and transposition. J Dermatol Surg Oncol. 1987;13(12):1348–53.
Rieger RA. A local flap for repair of the nasal tip. Plast Reconstr Surg. 1967;40(2):147–9.
Limberg AA. Design of local flaps. Mod Trends Plast Surg. 1966;2:38–61.
Bray DA. Clinical applications of the rhomboid flap. Arch Otolaryngol. 1983;109(1):37–42.
Masson JK, Mendelson BC. The banner flap. Am J Surg. 1977;134(3):419–23.
Zitelli JA. The bilobed flap for nasal reconstruction. Arch Dermatol. 1989;125(7):957–9.
Schulte DL, Sherris DA, Kasperbauer JL. The anatomical basis of the Abbe flap. Laryngoscope. 2001;111(3):382–6.
Eaglstein WH. Moist wound healing with occlusive dressings: a clinical focus. Dermatol Surg. 2001;27(2):175–81.
Gette MT, Marks Jr JG, Maloney ME. Frequency of postoperative allergic contact dermatitis to topical antibiotics. Arch Dermatol. 1992;128(3):365–7.
Smack DP, Harrington AC, Dunn C, Howard RS, Szkutnik AJ, Krivda SJ, et al. Infection and allergy incidence in ambulatory surgery patients using white petrolatum vs bacitracin ointment. A randomized controlled trial. JAMA. 1996;276(12):972–7.
Cruse PJ, Foord R. The epidemiology of wound infection. A 10-year prospective study of 62,939 wounds. Surg Clin North Am. 1980;60(1):27–40.
Author information
Authors and Affiliations
Corresponding author
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2012 Springer-Verlag London Limited
About this chapter
Cite this chapter
Sheehan, J.M., Rohrer, T.E. (2012). Flaps. In: Nouri, K. (eds) Mohs Micrographic Surgery. Springer, London. https://doi.org/10.1007/978-1-4471-2152-7_33
Download citation
DOI: https://doi.org/10.1007/978-1-4471-2152-7_33
Published:
Publisher Name: Springer, London
Print ISBN: 978-1-4471-2151-0
Online ISBN: 978-1-4471-2152-7
eBook Packages: MedicineMedicine (R0)