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FLAP MODIFICATIONS
FLAP MODIFICATIONS
The island pedicle flap is an excellent reconstructive option that allows for consistently reproducible results. Several design modifications have been introduced to accommodate defects in certain locations or other limitations to using the traditional design of this flap. While the central pedicle provides an excellent vascular supply, the bulkiness of this pedicle can sometimes impede flap mobility. Thus a modification using a laterally based pedicle may improve flap movement while also allowing for adequate perfusion. Dual island pedicle flaps can also be employed, with pedicles of differing sizes.
Unilateral island pedicle or single lateral island pedicle flap
This variation of the traditional island pedicle flap can be beneficial for nasal tip and alar defects. Unlike the conventional design, which maintains a central subcutaneous tissue pedicle, only one lateral edge remains attached while the rest of the pedicle is detached from the subcutaneous tissue. This laterally based pedicle can be comprised of subcutaneous fat or a muscular sling. This modification allows for even greater flap mobility, as the tissue can be more easily advanced or rotated into the defect. When used for defects on the distal nose a lateral pedicle based on the nasalis musculature may be employed, which allows for more predictable perfusion. In locations where nasalis muscle cannot be incorporated, a wider pedicle of laterally based subcutaneous tissue can be recruited.22
Dual (โbilateral,โ โdouble,โ or โbi-pedicledโ) island pedicle flaps
Dual island pedicle flaps are used in cases where a single island pedicle cannot be adequately mobilized to reach the distal edge of the defect. This repair can also be used for defects consisting of different tissue types, such as those involving both the upper cutaneous lip and mucosal lip.23 Dual island pedicle flaps may advance from opposite sides, or in opposite directions (horizontal and vertical).
In one variation, Huilgol et al. conducted a review of 10 patients with defects involving both the upper cutaneous lip and mucosal lip.23 Using cutaneous upper lip skin and mucosal skin, two island pedicle flaps were designed to fill their respective
defects. Once the pedicles were in position, the advancing edges were trimmed to simulate the shape of the vermillion/upper lip boundary. Cosmetic results were excellent. This variation may also be used on the scalp.