Coupon Accepted Successfully!


Random and Axial Flaps

  1. Local skin flaps are of two types:
    Flaps that rotate about a pivot point (rotation, transposition, interpolation flaps)
    Advancement flaps (single-pedicle advancement, V-Y advancement, Y-V advancement, and bipedicle advancement flaps).  
  2. Flaps Rotating About a Pivot Point
    1. Rotation, transposition, and interpolation flaps have in common a pivot point and an arc through which the flap is rotated.
    2. The radius of this arc is the line of greatest tension of the flap.
    3. The rotation flap is a semicircular flap of skin and subcutaneous tissue that rotates about a pivot point into the defect to be closed.
    4. A flap that is too tight along its radius can be released by making a short back-cut from the pivot point along the base of the flap.
    5. A triangle of skin (Burow’s trianglE. can be removed from the area adjacent to the pivot point of the flap to aid its advancement and rotation.
    6. The transposition flap is a rectangle or square of skin and subcutaneous tissue that also is rotated about a pivot point into an immediately adjacent defect.
    7. Bilobed flap: The key to a successful bilobed flap is an area of loose skin to permit direct closure of the secondary flap defect.

Description: Graphic copy   Rotation flaps

Description: Graphic copyTransposition flaps

Rotational flap

Description: Graphic copy

Transposition flap

Bilobed Flap

Limberg flap


  Four Limberg flap

  1. The Limberg flap is another transposition flap. This flap, like the bilobed flap and the Z-plasty, depends on the looseness of adjacent skin.
  2. A Limberg flap is suitable only for closure of rhomboid defects with angles of 60 and 120 degrees.
  3. With the Limberg flap, the sides are of the same length as the short axis of the rhomboid defect.  
  1. Advancement Flaps
    1. All advancement flaps are moved directly forward into a defect without any rotation or lateral movement.
    2. Modifications are the single-pedicle advancement, the V-Y advancement, and the bipedicle advancement flaps.
    3. The single-pedicle advancement flap is a rectangular or square flap of skin and subcutaneous tissue that is stretched forward.
    4. Advancement is accomplished by taking advantage of the elasticity of the skin and by excising Burow’s triangles lateral to the flap.


V-Y advancement


This V-Y technique can be used to lengthen such structures as the nasal columella, eliminate minor notches of the lip, and, in certain instances, close the donor site of a skin flap. 

  1. Skin Grafting
    1. Skin grafts are divided into 2 major categories: full-thickness skin grafts (FTSGs) and split-thickness skin grafts (STSGs). STSGs may be subdivided into thin (0.008- to 0.012-mm), medium (0.012- to 0.018-mm), and thick (0.018- to 0.030-mm) grafts.
    2. STSGs are most commonly used when:
      1. Cosmesis is not a primary concern or when the defect to be corrected is of a substantial size that precludes the use of an FTSG.
      2. Coverage of chronic unhealing cutaneous ulcers, temporary coverage to allow observation of possible tumor recurrence, surgical correction of depigmenting disorders with the use of suction blister grafts to line cavities such as the orbit, and coverage of burn areas to accelerate wound healing and to reduce fluid loss.
    3. The use of FTSGs is indicated:
      1. In defects in which the adjacent tissues are immobile or scarce.
      2. If that adjacent tissue has premalignant or malignant lesions and precludes the use of a flap.
    4. Specific locations for FTSGs include the nasal tip, helical rim, forehead, eyelids, medial canthus, concha, and digits.
    5. Other indications for the use of FTSG include punch grafting for hair transplantation and minigrafting (punch grafting) for the surgical correction of depigmenting conditions.
    6. Contraindications: Contraindications to the use of STSGs include the need to place the graft in areas where good cosmesis or durability is essential or where significant wound contraction could compromise function.
    7. The use of FTSGs is contraindicated when the recipient bed, due to lack of reasonable vascular supply, cannot sustain the graft. Using an FTSG on avascular tissues, such as exposed bone or cartilage, most often leads to graft necrosis.
    8. Uncontrolled bleeding in the recipient bed is another contraindication to the placement of an FTSG because hematoma and/or seroma formation under the graft compromises graft survival. 
  2. ​​Split-thickness skin grafts
    An appropriate donor sites are anterior, lateral, or medial part of the thigh; the buttock; or the medial aspect of the arm. For larger defects, a large, flat donor surface is ideal for harvesting an STSG.  
  3. Full-thickness skin grafts
    Common donor locations for FTSGs include areas of preauricular and postauricular, conchal bowl, supraclavicular, upper eyelid, nasolabial fold, axillary, antecubital, and inguinal fold skin.
    Wound contracture is more common in STSGs than in FTSGs, and it can lead to cosmetic and functional problems.


Full thickness graft can obtained from all of the following EXCEPT (AIIMS Nov 09)
A. Elbow
B. Supra clavicular
C. Groin
D. Axilla


Ans. D.

Test Your Skills Now!
Take a Quiz now
Reviewer Name