++
++
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.
++
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.
++
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.
++
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.
++
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.
++
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.
++
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.
++
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 ...