Name of the Procedure:

Delay of Flap or Sectioning of Flap (Division and Inset); at Forehead, Cheeks, Chin, Neck, Axillae, Genitalia, Hands, or Feet

Summary

Delay of flap or sectioning of flap involves repositioning a piece of tissue (flap) from one area of the body to another to cover a defect or wound. This procedure is commonly used on various parts of the body, including the forehead, cheeks, chin, neck, axillae, genitalia, hands, and feet.

Purpose

The procedure addresses significant tissue loss, wounds, or defects that cannot be closed with simple sutures or skin grafts. The goal is to provide healthy, vascularized tissue to promote healing, restore function, and improve the aesthetic appearance of the affected area.

Indications

• Large or complex wounds.
• Tissue defects due to trauma, surgery, or infection.
• Chronic non-healing ulcers.
• Reconstruction after cancer removal.
• Patient criteria include having adequate donor tissue and being in overall good health to tolerate surgery.

Preparation

• Fasting for at least 6-8 hours before the procedure.
• Adjusting or discontinuing certain medications as advised by the doctor.
• Preoperative blood tests, imaging studies, and physical examination.

Procedure Description

1. Anesthesia is administered to ensure the patient is comfortable, usually general or regional anesthesia.
2. The donor site (where the flap will be taken from) and the recipient site (where the flap will be moved to) are marked and prepared.
3. The flap is partially elevated but not completely detached from its blood supply and then repositioned.
4. Delay phase: The flap remains partially attached to allow development of a robust blood supply (can last from days to weeks).
5. Division and inset phase: The flap is completely separated from the donor site and securely positioned over the recipient defect.
6. Sutures are used to close the donor and recipient sites.
7. Dressing is applied to protect the surgical area.

Duration

The duration varies depending on the complexity, generally lasting from 1 to 4 hours.

Setting

The procedure is performed in a hospital, outpatient clinic, or surgical center.

Personnel

• Plastic or reconstructive surgeon
• Anesthesiologist
• Surgical nursing team

Risks and Complications

• Infection
• Bleeding or hematoma
• Flap necrosis (death of the tissue)
• Scarring or cosmetically unsatisfactory outcome
• Prolonged swelling or bruising
• Numbness or altered sensation

Benefits

• Effective closure of complex wounds or defects.
• Reduced risk of infection in the defect area.
• Improved functionality and appearance.
• Enhanced self-esteem and quality of life.

Recovery

• Follow-up appointments for wound care and to monitor healing.
• Activity restrictions, usually for a few weeks.
• Pain management with prescribed medications.
• Monitoring for signs of infection or complications.

Alternatives

• Skin grafting
• Artificial skin substitutes
• Negative pressure wound therapy (vacuum-assisted closure)
• Pros: Simpler options may be less invasive.
• Cons: May not provide as robust or aesthetic outcomes compared to flap procedures.

Patient Experience

The patient might feel some discomfort or pain post-surgery, effectively managed with pain medications. Swelling and bruising are common initially, but they subside over a few weeks. Supportive care and instructions from the healthcare team will aid in a smoother recovery process.