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ISLAND PEDICLE FLAPS

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SUMMARY

  • The V-Y island pedicle flap permits a triangular island of tissue to be advanced into a defect.

  • The flap relies on a robust vascular pedicle, and when properly designed is an effective technique for numerous defects.

  • The chief disadvantage of this approach is the increased risk for trapdooring and resultant undesirable scarring.

image Beginner Tips

  • Island pedicle flaps are frequently used on the lip, as their triangular scar line may be camouflaged within cosmetic subunit boundaries.

  • The fully circumferential suture lines and increased risk of trapdoor phenomenon mean that attention to detail in suturing techniques is of vital importance to camouflage the scar as effectively as possible.

image Expert Tips

  • Basting sutures at the base of the flap may help mitigate the risk of the trapdoor phenomenon, though care should be taken to avoid restricting blood flow to the pedicle.

  • In general, island pedicle flaps should be undersized relative to the defect size.

image Don’t Forget!

  • Undersizing island pedicle flaps means that there may be a significant component of secondary motion. This needs to be accounted for in order to avoid tissue distortion.

  • Island pedicle flaps are not purely advancement flaps; they may be rotated or transposed into place as well.

image Pitfalls and Cautions

  • Even though island pedicle flaps benefit from a robust vascular pedicle, they should be used with caution in smokers, who may have an increased risk of necrosis.

  • Always tailor flap design to the individual patient; flap elevation and undermining in patients on aspirin or other anticoagulants may increase the risk of hematoma formation.

image Patient Education Points

  • Patients should be warned prior to flap closure that they will have an incision stretching well beyond the initially visible defect.

  • Always advise patients that they may have a multistage procedure, and that trapdooring is likely to occur. Patients will be much more understanding regarding the need for intralesional steroid injection or other intervention if they were prewarned that this may occur.

image Billing Pearls

  • Flap repair codes (14040 and 14060 series) should be used for V-Y island pedicle flaps, and include the excision component, so it is not appropriate to bill both an excision and a flap repair code simultaneously.

  • Island pedicle flaps should not be coded with 15740, as this requires identification and dissection of a named axial vessel.

INTRODUCTION

Defects on cosmetically sensitive locations of the head and neck require delicate reconstruction to preserve anatomic function while also providing satisfying cosmesis to the patient.1–3 Options for repair range from second intention healing to complex surgical reconstruction. When chosen appropriately, flaps can provide excellent cosmesis and outcomes.4–6

Prior to flap repair, the surgeon should ensure that the tumor has been resected completely with clear histologic margins. Using flaps to repair the defect rearranges surrounding tissues, ...

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