Name of the Procedure:

Adjacent Tissue Transfer or Rearrangement
Common Name(s): Flap Surgery, Local Flap Reconstruction

Summary

An Adjacent Tissue Transfer or Rearrangement is a surgical procedure used to move healthy, adjacent tissue to cover a nearby area of skin defect or wound. This helps to achieve optimal healing and aesthetic results in the affected area.

Purpose

This procedure addresses skin defects or wounds, often resulting from trauma, surgery, or other conditions causing tissue loss. The goal is to promote healing, restore function, and improve the appearance of the damaged area.

Indications

• Large or complex skin wounds
• Skin cancer excision sites
• Trauma-induced tissue loss
• Chronic ulcers or burns
• Cosmetic enhancement after reconstructive surgery

Patients appropriate for this procedure typically have a defect measuring between 30.1 sq cm and 60.0 sq cm that cannot be effectively treated with simpler methods.

Preparation

• Patients may need to fast for a certain period before the procedure.
• Medication adjustments (e.g., stopping blood thinners) as directed.
• Preoperative assessment including blood tests, imaging studies, and a thorough medical examination.

Procedure Description

1. The patient is positioned and local or general anesthesia is administered.
2. The surgeon prepares the recipient site by cleaning and marking the area.
3. A flap of skin and underlying tissue is carefully designed and lifted from an adjacent area.
4. The tissue flap is rotated, advanced, or transposed to cover the defect.
5. The flap and donor site are meticulously sutured.
6. Dressings or a pressure bandage may be applied to help with healing and minimize swelling.

Tools and equipment used include scalpels, scissors, forceps, handheld cautery devices, and sutures. Anesthesia details depend on the size and complexity of the procedure.

Duration

The entire procedure typically takes between 1 to 3 hours, depending on the size and complexity of the defect and flap design.

Setting

Typically performed in a hospital or an outpatient surgical center.

Personnel

• Surgeon (often a plastic or reconstructive surgeon)
• Anesthesiologist or Nurse Anesthetist
• Surgical nurses
• Surgical technologists

Risks and Complications

• Common risks: infection, bleeding, swelling, and scarring.
• Rare risks: flap necrosis (tissue death), blood clots, nerve damage, and poor wound healing. Complications are managed with medications, wound care, or additional surgeries as needed.

Benefits

• Improved wound healing and functional recovery.
• Enhanced aesthetic outcomes with minimized scarring.
• Restoration of normal appearance and function. Benefits are typically realized within a few weeks to months post-surgery.

Recovery

• Post-procedure care includes keeping the wound clean and dry.
• Follow-up appointments to monitor healing.
• Avoiding strenuous activities for a few weeks.
• Pain can be managed with prescribed analgesics.
• Full recovery usually occurs within 4 to 6 weeks.

Alternatives

• Skin grafts: transfer of skin from another part of the body.
• Secondary intention healing: allowing the wound to heal naturally without surgical intervention.
• Healing with advanced wound care techniques. Pros and cons depend on the size and location of the defect, patient health, and aesthetic goals.

Patient Experience

During the procedure, patients will be under anesthesia and feel no pain. Post-procedure, they may experience mild to moderate discomfort, which is managed with pain medication. The area may be swollen and bruised initially but will improve over time with proper care and follow-up.