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# New AI Surgical Studio, 3 Local Flap Techniques, & Design the Rotation Flap (properly)
- URL: https://www.theplasticsfella.com/march-9th/
- Published: 2025-03-07T19:23:00.000Z
- Updated: 2025-03-08T21:01:14.000Z
- Description: Also: Final round of the Sunday quiz, pincushioning explained, & original local flap publications.
- Author: PlasticsFella
- Tags: thePlasticsPaper

#### In this week's edition

1. ****✍️** [****Letter from P'Fella**](https://www.theplasticsfella.com/march-9th/#a-letter-from-pfella)  
Stay tuned for: AI surgical studio.
2. ****🤓** [****The Sunday Quiz**](https://www.theplasticsfella.com/march-9th/#the-sunday-quiz)  
How well do you know **rotation flaps*?
3. [🖼️](https://emojipedia.org/framed-picture?ref=theplasticsfella.com) [****Image of the Week**](https://www.theplasticsfella.com/march-9th/#image-of-the-week)  
Featured: Keystone flap for defect reconstruction.
4. ****🚑** [****Technique Tip**](https://www.theplasticsfella.com/march-9th/#technique-tip)  
Principles of effective design for a rotation flap.
5. 🎓 [****The Fellow's Corner**](https://www.theplasticsfella.com/march-9th/#the-fellows-corner)  
The role of TXA in plastic and reconstructive surgery.
6. 📖 [****What Does the Evidence Say**](https://www.theplasticsfella.com/march-9th/#what-does-the-evidence-say)  
Why does pincushioning occur in local flaps?
7. ****🔥** [****Articles of the Week**](https://www.theplasticsfella.com/march-9th/#articles-of-the-week)  
Zitelli's original bilobed flap, original keystone flap publication & an overview of local flaps: with 1-sentence summaries.
8. 💕 [****Feedback**](https://www.theplasticsfella.com/march-9th/#feedback)  
Suggest ideas & give feedback!

## A Letter from P'Fella

**Stay Tuned for: AI Surgical Studio!*

👋

****Hey Team!**  
  
Surgical planning just got a major upgrade. ****AI Surgical Studio** is live, and it’s built for the way surgeons think, plan, and refine their techniques.

This isn’t just a drawing tool—it’s a **surgical studio** with precision controls, AI-powered feedback, and seamless workflow integration. Whether you’re mapping incisions, planning complex reconstructions, or prepping for exams, this changes the game.

We’ve combined **pro-grade drawing tools** with **AI-driven analysis** to bring surgical planning into the future:

- **Flawless Freehand & Incision Planning** – Draw, erase, and refine with pixel-perfect accuracy.
- **Real-Time Measurements** – **Ruler & angle tools** ensure precision at every step.
- **AI-Powered Second Opinion** – Get instant feedback on incision placement, symmetry, and design.
- **Smart Layer Management** – Organize complex surgical plans effortlessly.

![](https://storage.ghost.io/c/a0/9f/a09fd7b4-d396-4b28-aed3-b87e20483292/content/images/2025/03/image-1.png)

Right now, **Freestyle Mode** is fully functional—giving you complete control to map out all the key **flaps, incisions, and surgical plans** you need to prepare for. But we’re not stopping here - coming soon:

- **Guide Mode** – Assisted drawing with structured overlays and real-time AI adjustments to refine every step.
- **Exam Mode** – A challenge-based system to **test your decision-making and technique under pressure**, perfect for trainees and board prep.

### **Want Early Access? Join the Waitlist**

We’re building this for **surgeons, not just artists.** **Sign up for the waiting list now** to be the first to access **Guide Mode & Exam Mode** before the full release.

**P’Fella ❤️**

  
## The Sunday Quiz

**How Well Do You Know* ***Rotation Flaps?**

****Are you ready to make it to the leaderboard?**  
  
Welcome to the ****final** round of The Weekly Quiz.  
  
Each edition of thePlasticsPaper includes a quiz question designed to challenge and engage our readers. Keep your wits about you and join in every week — the winner at the end of six rounds will earn you a one-year subscription to thePlasticsPro.

![Overview of rotation flaps](https://storage.ghost.io/c/a0/9f/a09fd7b4-d396-4b28-aed3-b87e20483292/content/images/2025/03/Main-Article-Images---2025-03-07T233232.416.png)

Overview of rotation flaps

## Image of the Week

**Keystone Flap*

🖼️

****Image of the Week**   
  
In this section, we feature an anatomical illustration. This week’s image highlights the ****keystone flap**, a reliable local flap for defect reconstruction. 

![Keystone Flap](https://storage.ghost.io/c/a0/9f/a09fd7b4-d396-4b28-aed3-b87e20483292/content/images/2025/03/Keystone-Flap.png)

Keystone flap

## Technique Tip

**How to Design a Rotation Flap*

🚑

****Technique Tip of the Week**   
  
This week, we’re focusing on rotation flaps, a fundamental technique for closing circular defects with minimal tension.  
  
🔹 ****Key principle:** The flap should be ****at least 4x the defect radius** to allow adequate mobilization.  
🔹 ****Pivot point:** Strategically placed to maximize tissue movement while preserving vascularity.  
🔹 ****Back-cut:** Used sparingly to gain additional length but should be avoided if possible to maintain perfusion.  
  
Effective rotation flap design ensures optimal contour and tension-free closure.

![](https://storage.ghost.io/c/a0/9f/a09fd7b4-d396-4b28-aed3-b87e20483292/content/images/2025/03/image.png)

Rotation flap design

## the Fellows' Corner

**The Role of TXA in Plastic and Reconstructive Surgery*

📽️

****Role of Tranexamic Acid (TXA) in Plastic and Reconstructive Surgery: A National Perspective**  
  
**In case you missed it:* Dr. Hatan Mortada explores the role of ****TXA in plastic surgery** in our latest ****JPRAS**\-partnered journal article. Read it here👇

[Role of Tranexamic Acid (TXA) in Plastic and Reconstructive Surgery: A National PerspectiveTXA is widely used in plastic surgery, especially in facelifts (83.6%) and rhinoplasty (55.0%), reducing bleeding (61.8%) and bruising (63.2%). Common methods include 1 g IV bolus or 3% topical solution, with 92.4% reporting no complications. Despite benefits, standardization is needed.![](https://storage.ghost.io/c/a0/9f/a09fd7b4-d396-4b28-aed3-b87e20483292/content/images/icon/Logo-Small-2-3.png)thePlasticsFellaPlasticsFella![](https://storage.ghost.io/c/a0/9f/a09fd7b4-d396-4b28-aed3-b87e20483292/content/images/thumbnail/Lunchtime-Lessons-1.png)](https://www.theplasticsfella.com/journal-tranexamic-acid/)

## What Does the Evidence Say?

**Why Does Pincushioning Occur in Local Flaps?*

In this section, we dive deep into the latest research and evidence on medical practices and surgical techniques. 

****Pincushioning**, or the ****trapdoor effect**, is a common complication in ****transposition flaps**, particularly in nasal reconstruction. It occurs due to ****contraction of the flap** over the wound bed, leading to poor aesthetic outcomes (Kaufman et al., 1993; Okland et al., 2020).   
  
Several factors contribute to pincushioning, including ****lack of tissue undermining**, ****scar contracture**, and ****biomechanical factors** specific to the nasal region (Kaufman et al., 1993; Amici, 2014). Prevention techniques include ****wide tissue undermining**, ****thinning of excess subcutaneous tissue**, and ****primary lobe pexing sutures** (Kaufman et al., 1993; Okland et al., 2020; Boylan et al., 2021). Intraoperative triamcinolone injections have shown limited effectiveness (Boylan et al., 2021). Early ****corticosteroid injections** at the first signs of ****hypertrophy** can be an effective treatment (Amici, 2014).   
  
Proper flap design, delicate tissue handling, and tension-free closure are crucial in reducing complications (Woodard, 2013; Zitelli, 1989; Hom & Ostrander, 2023). 

## Articles of the Week

**3 Interesting Articles with 1 Sentence Summaries*

✅

****Zitelli’s Original Publication on Bilobed Flaps for Nasal Recon** ([Zitelli](https://jamanetwork.com/journals/jamadermatology/article-abstract/550671?ref=theplasticsfella.com), 1989)  
  
The bilobed flap is a versatile technique for reconstructing defects in the lower third of the nose, reducing pincushioning and optimizing contour by refining transposition angles.

✅

****Original Publication on the Keystone Design Perforator Island Flap** ([Behan](https://onlinelibrary.wiley.com/doi/abs/10.1046/j.1445-2197.2003.02638.x?sid=nlm%3Apubmed&ref=theplasticsfella.com), 2003)  
  
The Keystone Design Perforator Island Flap (KDPIF) is a versatile, vascularized local flap that minimizes skin grafting and achieves high primary wound healing rates, making it a reliable option for reconstructing skin defects.

✅

****Techniques and Applications of Local Flaps and Pedicled Perforator Flaps** ([Miranda](https://journals.lww.com/plasreconsurg/abstract/2013/06000/local%5Fflaps,%5Fincluding%5Fpedicled%5Fperforator%5Fflaps%5F.27.aspx?ref=theplasticsfella.com), 2013)  
  
Local perforator flaps offer a versatile reconstructive option by preserving vascular perforators, enabling tissue transfer with minimal donor-site morbidity, superior color and texture match, and primary closure.

## Feedback

### I hope you enjoyed it 😄

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