15600 Delay of flap or sectioning of flap (division and inset); at trunk

Name of the Procedure:

Delay of flap or sectioning of flap (division and inset); at trunk

Summary

This procedure involves the gradual preparation of a flap of skin and possibly underlying tissue for transfer to a different site on the trunk. This staged approach helps ensure the flap survives and integrates well with its new location.

Purpose

The procedure typically addresses issues requiring reconstructive surgery, such as significant defects from trauma, infection, or tumor removal. The goal is to ensure a dependable blood supply to the flap, optimizing the chances for successful healing and functionality.

Indications

• Large or complex wounds on the trunk.
• Tissue loss due to infection or trauma.
• Tissue defects from surgical removal of tumors.
• Chronic non-healing wounds requiring reconstruction.

Preparation

• Patients may need to fast for a certain period before the procedure.
• Adjustments to medications, especially blood thinners, as advised by the healthcare team.
• Pre-procedure assessments like blood tests, imaging studies (e.g., CT, MRI), and medical history review.

Procedure Description

1. Initial Surgery (Delay Phase):

   • The surgeon identifies and partially lifts a flap of skin and tissue while keeping it attached at one end to maintain blood flow.
   • Strategic incisions are made to improve the flap’s blood supply.

2. Waiting Period:

   • A period of days to weeks follows, allowing new blood vessels to form in the flap.

3. Second Surgery (Division and Inset Phase):

   • The flap is fully detached from its original location.
   • The flap is then moved and sutured into the defect site on the trunk.
   • Ensuring proper alignment and blood supply is critical.
   • Typically performed under general anesthesia.

Duration

The entire process can span from a few days to several weeks, with each surgical phase taking several hours.

Setting

This procedure is performed in a hospital or a specialized surgical center equipped for comprehensive post-operative care.

Personnel

• A plastic or reconstructive surgeon.
• Anesthesiologist.
• Surgical nurses and technicians.
• Post-operative care team, including nurses and possibly physical therapists.

Risks and Complications

• Infection at the surgical site.
• Bleeding or hematoma formation.
• Partial or complete loss of the flap due to inadequate blood supply.
• Scarring and need for further corrective surgeries.
• Risks associated with anesthesia.

Benefits

• Restoration of form and function to the trunk area.
• Improved aesthetic appearance.
• Enhanced healing of the affected area.
• Long-term durability and integration of the flap.

Recovery

• Patients may need to stay in the hospital for a few days post-surgery.
• Detailed wound care instructions will be provided.
• Physical activity restrictions to ensure proper healing.
• Follow-up appointments for monitoring progress and addressing any issues.
• Complete recovery may take several weeks to months, depending on the complexity.

Alternatives

• Skin grafts: Less complex but may not be suitable for large or deep defects.
• Local flap transfer: Involves nearby tissue and may limit tissue availability.
• Advanced wound therapy: Non-surgical options that might include negative pressure wound therapy.

Patient Experience

Patients may experience discomfort or pain managed by prescribed medications. Swelling, bruising, and restricted movement are common initially. Over time, as healing progresses, patients often regain normal function and appearance of the affected area.

Pain management includes medications and supportive care. The healthcare team will provide measures to ensure the patient’s comfort throughout the recovery process.