Soft Tissue Coverage at the Resource

Challenged Facility

Nguyen Anh Tuan and Coll.,University Medical Center,

Ho Chi Minh City, Viet Nam

Foreword

• Soft tissue defect (STD) can present in many fiels: traumatology, oncology, neuro-surgery, orthopaedic…

• STD is challenge in many cases.

• Resolve STD need: earlly, good material, good blood supplying.

• flaps have an importance place.

STEPS TO CLOSE THE WOUND

FREE FLAPS

AREA FLAPS

LOCAL FLAPS-PEDICLE FLAPS

PRIMARY CLOSE.

FLAP DEFINITION

A flap is a unit of tissue that is transferred from one site (donor site) to another (recipient site) while maintaining its own blood supply.

Many different methods have been used to classify flaps.

In maintaining blood supply we have: pedicle and free flap.

ADVANTAGES OF FLAPS

Close the wound.Fill the holes, dead space…Blood supply: muscle flaps better

skin flaps.Anti-infection.…

Pedicle flap

A flap consisting of the tissue, attached (preserve) by tissue through which it receives its blood supply .EX:

Radial flap.

Posterior interosseous flap.

Fascia cutaneuos flap.

Sural flap…

FREE FLAPS

The terms free flap and free tissue transfer are synonymous labels used to describe the movement of tissue from one site on the body to another.

Free flaps need to do micro-anastomosis.

Free flap is almost exclusively practiced by plastic surgeons

SUBJECTS

I’ll show you my cases in:

•Pedicle flaps.

•Free flaps.

Pedicle flaps (1)

Indication: Small or medium defect.Local or area tissue in good

condition.Patients in stable condition.Do not have micro-surgery team.

Pedicle flaps (2)

Radial flap.Posterior interosseous flap.Fascia cutaneuos flap.Sural flap…

SIGN-2007.7

SIGN-2007.8

Neuro-cutaneous Flap from forearm

• Give material the same to radial (Chinese) flap.

• Easy to harvest.

• Do not sacrifice main blood vessel.

SIGN-2007.16

Branch A: PY: 52%

Branch B: PY: 93%

Branch C: PY 63%

ANTEROLATERAL THIGH FASCIOCUTANEOUS (ATF) FLAP

Indication of ATF flap

Pedicle flap:

• Proximally based flap: lower abdominal, peritoneal area, thigh.

• Distally based flap: thigh, knee.

Free flap:

• Large area.

Flaps from posterior part of leg

Distally based pedicle flaps:

• Sural flap (neuro-cutaneous f.).

• Posterior fascio-cutaneous flap.

• Postero-medial fascio-cutaneous flap.

• Postero-lateral fascio-cutaneous flap.

FREE FLAPS

Indication:

• Medium or large defect.

• Local or area tissue are not good.

• Patient in stable condition.

CONCLUSION

Soft Tissue Coverage in many cases can resolve by pedicle and free flap.

Pedicle and free flaps have many advantages:Have good blood supplying.Can do in earlly time.Give good material to coverResolve STD from small to large size.

THANK YOU for YOUR ATTENTION