Perineal reconstruction uses local, regional, or free flaps, often gracilis or VRAM, to close oncologic, traumatic, or infectious defects. Goals: fill dead space, provide vascular coverage, protect pelvic organs, preserve continence and sexual function, and cut wound issues.
Scalp reconstruction balances inelastic hair-bearing skin, robust dual blood supply, & curved skull. Small defects use primary closure, VAC, second intention, or skin anchors. Grafts need a vascular bed and no planned radiation. Larger gaps need local, rotation, or advancement flaps.
Chest-wall reconstruction restores support, organ protection, ventilation, & contour after tumour resection, trauma, or infection. Defects > 5 cm or ≥ 4 ribs need rigid mesh/PTFE/titanium plus vascular flaps (pectoralis, lat dorsi, rectus). Sepsis or poor lung reserve contraindicate.
Hartrampf divides lower‑abdominal TRAM/DIEP flaps into four perfusion zones around the dominant perforator: Zone I being best, and Zone IV worst. Later imaging showed ipsilateral lateral tissue (Zone III) may out‑perfuse contralateral medial (Zone II) & that patterns shift with perforator row.
Microsurgery employs magnification, delicate tools, and 8-0–11-0 sutures to join vessels/ nerves ≤2 mm, powering free flaps, replantation, nerve and lymphatic repair. Outcomes rely on ergonomic setup, meticulous vessel prep, apt end-to-end or end-to-side stitches, and vigilant flap monitoring.
Flap vascular compromise, arterial ischaemia or venous congestion, usually emerges within 72 h post‑op. Watch colour, cap‑refill, Doppler/NIRS. Early re‑exploration or adjunct venous‑drainage within 6 h can salvage >60 % of flaps; delays sharply cut survival.
Fasciocutaneous flaps use skin, fat, and fascia (without muscle) for thin, pliable, well-vascularized coverage. Supplied by perforator-fed plexuses, they’re classified by vascular entry or pedicle type. Ideal for trauma and oncologic reconstruction, with low donor morbidity and muscle preservation.
The DIEP flap is a gold standard for autologous breast reconstruction, offering superior vascularity and minimal donor-site morbidity.
Penile reconstruction addresses tissue loss from trauma, fibrosis, cancer, and infection. The primary goal is to construct a phallus with a neo-urethra for standing urination and sufficient bulk for a prosthesis. Techniques include glans, shaft, and scrotal reconstruction.
Thatte and Thatte classify venous flaps into three types based on vein number and function. Venous flaps are infrequently used due to low survival rates and venous congestion, despite their reliable anatomy and minimal donor site morbidity.
The Mathes and Nahai Classification, introduced in 1981, describes the vascular supply to muscle and musculocutaneous flaps based on major and minor pedicles. This system is essential for planning reconstructive surgeries to ensure optimal flap survival and function.
The radial artery forearm flap is a fasciocutaneous flap. This article details the flap's anatomy, elevation, and dissection.
The VRAM Flap is a Type III Mathes & Nahai myocutaneous flap. This article details its indications, anatomy, and surgical technique.
This article details the anatomy, technique, indications, benefits and disadvantages of the gracilis flap.
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