Name of the Procedure:

Delay of Flap or Sectioning of Flap (Division and Inset); at Eyelids, Nose, Ears, or Lips
Technical Terms: Flap delay, flap division and inset

Summary

This surgical procedure involves partially cutting and relocating a section of tissue (flap) from one area to another to repair defects or improve functionality and appearance. Commonly performed on delicate areas like the eyelids, nose, ears, or lips, it typically requires multiple stages to ensure proper healing and integration of the grafted tissue.

Purpose

Medical Condition or Problem: Used to repair defects due to trauma, surgery, congenital anomalies, or diseases. Goals/Expected Outcomes: Improved functionality, enhanced appearance, and better healing of the treated area.

Indications

• Deformities or defects resulting from trauma or surgery
• Congenital anomalies like cleft lip or palate
• Tissue loss due to cancer resection or other diseases
• Non-healing wounds or scars requiring reconstruction

Patient Criteria:

• Adequate blood supply to both donor and recipient sites
• General good health to withstand the procedure

Preparation

• Pre-Procedure Instructions: Fasting if general anesthesia is required, cessation of certain medications (e.g., blood thinners), and preoperative bathing and skincare.
• Diagnostic Tests/Assessments: Blood tests, imaging studies (like CT or MRI), and a thorough physical examination.

Procedure Description

1. Initial Assessment: Marking the donor and recipient sites while ensuring adequate blood supply.
2. Anesthesia: Administered local or general anesthesia based on the extent of the surgery.
3. First Stage - Flap Delay: Partial incision of the flap to increase blood flow while still attached to its original site.
4. Healing Period: Allowing the initial incision to heal and improve blood supply over days or weeks.
5. Second Stage - Flap Division: Complete the incision, detach the flap, and inset it into the defect site.
6. Closure: Both donor and recipient sites are meticulously sutured.
7. Dressing: Application of sterile dressings to protect the surgical area.

Tools/Equipment: Scalpels, surgical scissors, sutures, sterile drapes, and wound dressings.

Duration

The procedure typically takes 1-3 hours, depending on complexity and site.

Setting

Performed in a hospital surgical suite, outpatient surgical center, or specialized clinic.

Personnel

• Surgeon: Plastic or reconstructive surgeon
• Nurse: Scrub nurse and circulating nurse
• Anesthesiologist/Anesthetist: Oversees anesthesia administration
• Surgical Technician: Assists with instruments and supplies

Risks and Complications

• Common Risks: Infection, bleeding, scarring
• Rare Risks: Flap necrosis, poor wound healing, unsatisfactory cosmetic result
• Management: Antibiotics, wound care, possible revision surgery

Benefits

• Expected Benefits: Functional restoration, improved appearance, and better tissue healing.
• Timeline for Benefits: Typically noticeable within a few weeks post-procedure, with full benefits often seen after several months.

Recovery

• Post-Procedure Care: Regular dressing changes, prescribed medications for pain and infection prevention, and follow-up appointments.
• Recovery Time: Generally, 2-4 weeks for initial recovery, with full stabilization over months.
• Restrictions: Avoid strenuous activities, follow wound care instructions, attend all follow-up visits.

Alternatives

• Other Treatment Options: Skin grafts, free flap procedures, non-surgical approaches like fillers or prosthetics.
• Comparison: Flap delay offers more natural and integrated results but involves a longer and more complex process compared to alternatives.

Patient Experience

• During Procedure: Under anesthesia, so minimal awareness or discomfort.
• After Procedure: Some pain, swelling, and bruising managed with prescribed medications and ice packs. Specific instructions to ensure comfort and proper healing.