Name of the Procedure:

Adjacent Tissue Transfer or Rearrangement, Trunk; Defect 10.1 sq cm to 30.0 sq cm
Common name(s): Local Flap Surgery, Tissue Flap Procedure

Summary

Adjacent tissue transfer or rearrangement is a surgical procedure used to repair a defect in the skin on the trunk (chest, abdomen, back) by moving nearby healthy tissue into the damaged area. This technique covers and heals wounds that are too large to be closed by simple stitches.

Purpose

The primary purpose of this procedure is to repair and close moderate to large skin defects on the trunk. This can involve closing wounds from injury, correcting surgical excision sites (e.g., after tumor removal), or treating congenital defects. The goal is to achieve wound closure, restore tissue function, and achieve a visually acceptable appearance.

Indications

• Large skin defects from trauma or surgery
• Chronic ulcers or wounds that do not heal
• Skin cancer excision sites
• Congenital skin malformations or deformities
• Inability to close a wound with simple sutures due to tension

Preparation

• Pre-procedure consultation to discuss medical history and expectations
• Fasting may be required if general anesthesia is used
• Blood tests or imaging studies (e.g., MRI, CT scan) to evaluate the defect area
• Adjustments to current medications as instructed by your doctor (e.g., stopping blood thinners)

Procedure Description

1. The patient is given appropriate anesthesia (local or general) for comfort.
2. The surgeon makes an incision around the defect and designs a flap of nearby healthy skin and underlying tissue.
3. The flap is carefully elevated, rotated, or moved to cover the defect area.
4. The flap is then sutured into place, and the donor site (where the flap was taken from) is closed with stitches.
5. Dressings are applied to protect the surgical sites.

Duration

The procedure typically takes about 1 to 3 hours, depending on the size and complexity of the tissue defect.

Setting

• Hospital operating room or specialized outpatient surgical center

Personnel

• Plastic or general surgeon
• Surgical assistants or nurses
• Anesthesiologist (if general anesthesia is used)
• Operating room staff

Risks and Complications

• Infection
• Bleeding
• Scarring
• Flap failure (loss of blood supply to the transferred tissue)
• Numbness or changes in skin sensation
• Need for additional surgeries

Benefits

• Effective repair of large skin defects
• Improved functional recovery and appearance of the trunk area
• Enhanced wound healing and reduced risk of complications from open wounds

Recovery

• Close monitoring of the surgical site for signs of infection or complications
• Pain management with prescribed medications
• Restricted physical activity for several weeks to allow proper healing
• Follow-up appointments to assess healing and remove stitches if needed
• Average recovery time ranges from a few weeks to a few months, depending on the individual's health and complexity of the surgery

Alternatives

• Direct wound closure with sutures
• Skin grafting
• Negative pressure wound therapy (wound VAC)
• Conservative management with dressings and wound care Pros and cons of alternatives:
• Simpler procedures may not be effective for larger defects
• Skin grafts may have differences in color and texture compared to nearby skin
• Conservative measures might prolong healing and involve more frequent care

Patient Experience

• During the procedure: Minimal awareness if general anesthesia is used; local anesthesia with possible sensation of tugging and pressure.
• After the procedure: Expect some pain and discomfort managed with medication, swelling, and bruising around the surgical site. Regular dressing changes and keeping the area clean is critical for proper healing. Most patients can gradually resume normal activities after a few weeks but should follow medical advice for specific restrictions.

Pain management and comfort measures include prescribed painkillers, cold compresses to reduce swelling, and wearing loose clothing to minimize irritation.