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INTERPOLATION FLAPS

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SUMMARY

  • Interpolation flaps are very effective for large or deep defects, as their robust vascular supply allows closure of distant defects.

  • Most interpolation flaps require at least two stages, and the degree of local care and functional and cosmetic compromise between stages means that appropriate patient selection is of vital importance.

  • The paramedian forehead flap is the most frequently used interpolation flap in dermatologic surgery, though cheek-to-nose, paranasal, postauricular, lip, and eyelid interpolation flaps are used as well.

image Beginner Tips

  • The surgeon should precisely design a template that accounts for the three-dimensional shape and contour of the nose.

  • Doppler localization of the underlying axial vessel may not be needed.

  • It is best to match the thickness and contour as much as possible during the initial inset, though a delicate balance must be maintained as aggressive thinning in the first stage may increase the risk of ischemia.

image Expert Tips

  • The Abbé flap may result in difficulty with eating or speaking prior to flap division.

  • This flap may also appear markedly edematous for up to a year postoperatively, and no revisions should be attempted prior to 6 months to allow this swelling to resolve. Sensory and motor functions are affected during the procedure and it may require a year or more to regain complete neuromuscular function.

  • The three-stage paramedian forehead flap may provide a superior cosmetic outcome, though an additional surgical procedure is required.

image Don’t Forget!

  • An oversized flap, or a flap that has not been appropriately thinned, may require a revision with another surgery, intralesional steroids, dermabrasion, or laser.

  • Necrosis may be seen more often with the cheek-to-nose flap compared to other interpolation flaps due to its less robust blood supply.

image Pitfalls and Cautions

  • All patients should be counseled that additional revisions such as dermabrasion or contouring may be required at a later date.

  • For the Abbé flap, patients should be appropriately counseled regarding the anticipated difficulty with eating and speaking prior to pedicle division.

  • Lymphedema lasting many months is common after eyelid interpolation flaps.

image Patient Education Points

  • From the patient’s perspective, staged interpolation flaps are among the most challenging closures in dermatologic surgery, as they must care for and endure an unsightly pedicle for several weeks postoperatively.

  • Paresthesias secondary to transection of the supratrochlear nerve can be permanent, and patients should be counseled about this prior to surgery.

image Billing Pearls

  • Interpolation flaps on the nose, eyelids, and lips are coded with 15576 at the time of pedicle formation and 15630 at the time of takedown.

  • Like all flap codes, there is a 90-day global period associated with these codes.

INTRODUCTION

A large, complex facial defect may create permanent disfigurement and significant psychological morbidity. While cosmetic expectations differ among patients, all desire to retain a normal-appearing face. Surgeons have many reconstructive ...

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