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- Presentation
Extranasal Transposition Flaps
Description
In this presentation, June Zhang, a MO surgeon, discusses the principles and execution of extranasal transposition flaps, focusing on their design and utility in clinical scenarios. Transposition flaps are particularly useful for redirecting tension vectors away from critical areas, such as eyelids, and accessing non-adjacent tissue reservoirs, often facilitating the closure of surgical defects without compromising delicate structures. The talk covers key concepts for flap design, including the placement of the last flap lobe in a favorable tissue reservoir to optimize movement, and the influence of tension vectors on flap behavior. Zhang emphasizes the importance of avoiding distortion of free margins, especially in facial areas, and demonstrates these principles through case examples, highlighting techniques for flap creation, suturing, and the incorporation of tacking sutures to minimize tension and optimize flap position. Additionally, considerations for multi-lobed versus single-lobe flaps are addressed, as well as practical execution tips for undermining and elevating flaps in various anatomical locations. The talk concludes by recapping the essential design principles and offering resources for further reading on flap techniques.
View moreConclusions
- Transposition flaps are beneficial for redirecting tension vectors during closure to avoid distortion of free margins.
- These flaps are especially useful for accessing nearby tissue reservoirs that are non-adjacent to the defect.
- Design principles in flap surgery emphasize adapting each flap to the unique characteristics of the surgical defect and surrounding tissue.
- Primary tension vector positioning is crucial for effective flap movement, requiring careful consideration of the last lobe's placement.
- Optimal flap movement can be achieved by placing the last lobe in a favorable tissue reservoir with natural laxity.
- Secondary motion, or the motion of surrounding tissue needed to help close the defect, must be minimized to prevent complications.
- The nature of the tissue—pliable vs. rigid—affects flap design and execution, with extra nasal flaps being more forgiving than nasal flaps.
- Tacking sutures can help relieve tension on surrounding structures, facilitating better flap placement and reducing distortion.
- Flap sizing should consider how much secondary motion can be tolerated and the impact of flap size on aesthetic outcomes.
- Miller CJ et al. J Am Acad Dermatol, 2015.
- Blake BP, Simonetta CJ, and Maher IA. Transposition flaps: principles and locations. Dermatol Surg
- Dzubow LM. The dynamics of flap movement: effect of pivotal restraint on flap rotation and transposition. J Dermatol Surg Oncol 1987;13.
- Dzubow LM. Design of an appropriate rhombic flap for a circular defect created by Mohs microscopically controlled surgery. J Dermatol Surg Oncol 1988;14.
- Miller CJ. Design principles for transposition flaps: the rhombic (single-lobed), bilobed, and trilobed flaps. Dermatol Surg 2014;40:S43-S52.
- Scott JF and Bordeaux JS. A conceptual approach to designing transposition flaps. Dermatol Surg 2020; 46:9-19.
- Steele RB, Jellinek NJ, Foy A, Lee K, Vij A, Knackstedt TJ. Use of extranasal bilobed transposition flaps in cutaneous reconstructive surgery at 2 institutions. Dermatol Surg 2020;46:1279-1285.