Formation of Direct or Tubed Pedicle, with or without Transfer; Trunk

Name of the Procedure:

Common Name: Pedicle Flap Surgery
Medical Term: Formation of Direct or Tubed Pedicle, with or without Transfer; Trunk

Summary

Pedicle flap surgery involves moving a section of tissue along with its blood supply from one part of the body to another to cover defects or wounds. This can include a direct pedicle (the tissue remains partially attached to its original location) or a tubed pedicle (the tissue is formed into a tube for transfer).

Purpose

This procedure is performed to address large wounds or defects in the trunk area that cannot be closed by simpler methods. The primary goal is to promote healing by providing a well-vascularized tissue, thus reducing the risk of infection and improving functional and cosmetic outcomes.

Indications

• Large or complex wounds on the trunk
• Tissue loss due to trauma, infection, or surgery (e.g., tumor removal)
• Chronic ulcers or non-healing wounds
• Patients needing reconstruction following mastectomy or other major surgical procedures

Preparation

• Patients may be required to fast for at least 8 hours before the surgery.
• Medication adjustments may be necessary, including stopping blood thinners.
• Pre-operative imaging studies, such as CT or MRI, to map the blood vessels supplying the flap.
• Blood tests and a general health assessment to ensure patient suitability for surgery.

Procedure Description

1. Anesthesia: The patient is placed under general anesthesia.
2. Incision: A surgical incision is made around the donor site from where the tissue will be taken.
3. Flap Formation: The surgeon prepares the flap, ensuring its blood supply is maintained.
4. Transfer: The flap is then moved to cover the defect on the trunk. If using a tubed pedicle, the tissue is shaped into a tube for transfer.
5. Attachment and Closure: The flap is carefully sutured into place and any remaining donor site wound is closed.

Tools and Equipment:

• Surgical knives and scissors
• Sutures and surgical staples
• Microsurgical instruments for blood vessel anastomosis

Duration

The procedure typically takes between 4 to 6 hours, depending on its complexity.

Setting

Pedicle flap surgery is usually performed in a hospital operating room.

Personnel

• Primary Surgeon (typically a plastic or reconstructive surgeon)
• Anesthesiologist
• Surgical Nurses
• Scrub Technicians

Risks and Complications

• Common Risks: Infection, bleeding, and scarring.
• Rare Complications: Flap necrosis (tissue death), blood clot formation, and failure of the flap to integrate.

Benefits

• Effective coverage and healing of large or complex wounds.
• Reduced risk of infection and further complications.
• Improved functional and aesthetic outcomes.

Recovery

• Post-Procedure Care: Regular dressing changes, monitoring for signs of infection, and possibly antibiotics.
• Expected Recovery Time: Generally, full recovery can take several weeks to months, with restrictions on physical activity to allow proper healing.
• Follow-Up Appointments: Regular follow-up to monitor healing and ensure flap viability.

Alternatives

• Skin Grafts: Suitable for smaller areas, but may lack the vascular support needed for large defects.
• Primary Closure: Only an option for smaller defects.
• Negative Pressure Wound Therapy: Can be used adjunctively with other treatments.

Patient Experience

• During the Procedure: The patient will be under general anesthesia and will not feel pain.
• After the Procedure: Discomfort or pain at both the donor and recipient sites, managed with prescribed pain medication. Swelling and bruising are common and will subside over time.

Pain Management and Comfort Measures:

• Use of pain relief medications
• Keeping the surgical sites clean and dry
• Gentle movements to avoid strain on the affected areas