15740 Flap; island pedicle requiring identification and dissection of an anatomically named axial vessel

Name of the Procedure:

Flap; Island Pedicle Requiring Identification and Dissection of an Anatomically Named Axial Vessel

Summary

This procedure involves creating a flap of skin and tissue that maintains its own blood supply via a defined artery or vein, known as an axial vessel. The flap is used to cover and repair areas of the body with significant tissue loss.

Purpose

The primary goal of the island pedicle flap procedure is to cover and repair areas of damaged or deficient tissue, often due to trauma, surgery, or chronic conditions. The procedure enhances healing and restores function and appearance.

Indications

• Severe skin and tissue loss from trauma or surgery
• Chronic non-healing wounds
• Pressure ulcers
• Post-tumor excision reconstruction
• Congenital or acquired deformities

Preparation

• Patients may be required to fast 6-8 hours before the procedure.
• Medication adjustments, especially anticoagulants, may be necessary.
• Preoperative assessments, including blood tests and imaging studies like CT or MRI, to map the vessel anatomy and plan the flap.

Procedure Description

1. The patient is positioned and anesthetized, typically under general anesthesia.
2. The surgeon identifies the anatomically named axial vessel in the donor site.
3. Incisions are made to outline the flap, ensuring the vessel is included.
4. The flap is carefully dissected, preserving its blood supply.
5. The flap is transposed to the recipient site and attached.
6. The donor and recipient sites are sutured, ensuring adequate blood flow to the flap.

Duration

The procedure typically takes 2 to 4 hours, depending on the complexity and size of the flap.

Setting

The procedure is performed in a hospital operating room or a specialized surgical center.

Personnel

• Plastic or reconstructive surgeon
• Anesthesiologist or nurse anesthetist
• Surgical nurses
• Surgical technician

Risks and Complications

• Infection at the donor or recipient site
• Bleeding or hematoma
• Flap necrosis (loss of blood supply to the flap)
• Scarring
• Nerve damage
• Anesthetic complications

Benefits

• Restoration of function and appearance to the affected area.
• Improved wound healing and reduced risk of further complications.
• Enhanced quality of life and mobility.

Recovery

• Immediate postoperative care includes monitoring in a recovery room.
• Instructions on wound care, activity restrictions, and follow-up visits.
• Pain management typically involves prescribed analgesics.
• Recovery can vary from several weeks to a few months, with specific instructions tailored to the patient’s condition.

Alternatives

• Skin grafts: Suitable for smaller defects or those not requiring complex blood supply.
• Secondary intention healing: Allowing the wound to heal naturally, which might take longer and have less satisfactory cosmetic results.
• Synthetic or biological wound dressings: Used in cases less severe than those needing extensive flap reconstruction.

Patient Experience

During the procedure, patients are under general anesthesia and will not feel pain. Postoperatively, there may be discomfort or pain at both the donor and recipient sites, which can be managed with medications. Patients might experience swelling and bruising initially, with gradual improvement over time. Regular follow-up appointments are important to ensure proper healing and to manage any complications.