This is because twisting of the vascular pedicle results from rotation of the flap and should be limited to prevent interference with the bloodstream. The three single-lobe rotation flaps possess all of the advantages of local or classic rotation flaps and permit the use of unusually large flaps. The plantar hallux also allows adequate tissue mobility for a single-lobe flap (Fig. Banner transposition flap. 17.13). Field LM. In perforator flap surgery, wide exposure of the perforator is mandatory during dissection and is easily obtained by splitting the GM fibers longitudinally. The rhomboid flaps are then chosen according to the requirements of the local situation. 21.29). The resultant primary and secondary skin movement reduces the size of the formerly round defect so that the shape of the closed defect corresponds more or less to that of the flap. We present a case in which a banner transposition flap from the preauricular and mandibular area of the cheek resulted in an excellent cosmetic outcome. This technique is also useful on the lower leg for removal of premalignant or suspected lesions where the final scar has more cosmetic importance (Fig. Ideally, functional and cosmetic deficits created by the tumor or the surgery should be addressed in a single stage, concomitant with the oncologic resection. Methods. This seems most well-situated in the majority of circumstances on the lower extremities. Transposition "banner" flaps of the torso. The created flap narrows to its point and the incisions in all three flaps are never made parallel. The most common transposition flaps in cutaneous surgery include rhombic flaps (and their variations), bilobed flaps, and banner flaps such as the nasolabial flap. It may also be useful to firmly tack the flap to the underlying wound in one or several locations to prevent the development of a potential dead space along the lengthy flap. The technique employed in this reconstruction is described and previously reported techniques are reviewed. USA.gov. If the rotation angle exceeds 90°, the pedicle of the flap should be positioned to form an arc in order to avoid acute twisting of the vascular pedicle. 17.16).  |  A rhombus is an equilateral parallelogram with (1) acute angles of 60° and obtuse angles of 120°, (2) long and short diagonals perpendicular to each other, and (3) a short diagonal equal in length to each side of the rhombus. From: Lower Extremity Soft Tissue & Cutaneous Plastic Surgery (Second Edition), 2012, Sumner A. Slavin, ... Arin K. Greene, in Supportive Oncology, 2011, Flap transpositions attempt to connect superficial lymphatics to the deep system. ScienceDirect ® is a registered trademark of Elsevier B.V. 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URL: https://www.sciencedirect.com/science/article/pii/B9781437710151000217, URL: https://www.sciencedirect.com/science/article/pii/B9780323523776000148, URL: https://www.sciencedirect.com/science/article/pii/B9780702031366000187, URL: https://www.sciencedirect.com/science/article/pii/B9781416046653000548, URL: https://www.sciencedirect.com/science/article/pii/B9780323027526500262, URL: https://www.sciencedirect.com/science/article/pii/B9780721605197000289, URL: https://www.sciencedirect.com/science/article/pii/B9780323034708001319, URL: https://www.sciencedirect.com/science/article/pii/B9780721605197000101, URL: https://www.sciencedirect.com/science/article/pii/B9780323034708000028, URL: https://www.sciencedirect.com/science/article/pii/B9780702031366000175, Lower Extremity Soft Tissue & Cutaneous Plastic Surgery (Second Edition), 2012, Lower Extremity Soft Tissue & Cutaneous Plastic Surgery (Second Edition), Anterior and Subtemporal Approaches to the Infratemporal Fossa, Ricardo L. Carrau, ... Moisés A. Arriaga, in, Jonathan L Cook MD, Glenn D Goldman MD, in, Raymond Tse MD, FRCSC, ... Vincent R Hentz MD, in, Plastic Surgery Secrets Plus (Second Edition), Jeffrey Weinzweig MD, FACS,, Norman Weinzweig MD, FACS, in, Journal of Plastic, Reconstructive & Aesthetic Surgery, Facial Plastic Surgery Clinics of North America. Medial lower eyelid defects are suitable for repair with a banner flap transposed from the nasofacial sulcus. Myocutaneous and omental flap transposition have variable efficacy.81–83 Omental flaps have been associated with substantial donor-site morbidity without evidence of long-term success.84. These flaps are designed and elevated along existing facial junctions or relaxed skin tension lines and are transposed … There is also a special resistance of the flap, resulting from the broad base that helps to ensure a good blood supply. The technique allows excellent exposure to underlying tissues, complete removal of most circular or oval lesions and complete closure of the resultant defect. The technique allows aesthetically acceptable reconstructions on the trunk by attention to detailed planning. Most commonly, a temporalis muscle transposition flap is adequate to separate the cranial cavity from the upper aerodigestive tract and obliterate the dead space. Lower cranial nerve deficits may be ameliorated by laryngeal framework surgery, tracheotomy, or laryngotracheal separation, as previously discussed. When the flap is designed as a transposition flap for sacral defects, it is better to harvest the skin paddle on a healthy tissue as a transposition flap. The flap arrangement shown in Figure 18.12 is infrequently utilized in comparison to the flap arrangement in Figure 18.13. It has universal applicability with reference to the size and location of the defect. The technique allows aesthetically acceptable reconstructions on the trunk by attention to detailed planning. 17.14). 2016 Oct;36(7):546-551. doi: 10.1002/micr.22408. These needs are usually anticipated during the surgical planning, and the patient and consultants (e.g., the microvascular surgeon) are informed accordingly. Therefore, the size of the flap should be made longer to compensate for loss of the pedicle length according to the direction of the flap transposition. The banner flap is particularly suited to oval or oblong defects that are oriented essentially perpendicular to the line of harvest of the flap. This flap has an extremely large base that preserves blood supply, but frequently results in tissue protrusion or a dog-ear defect at the secondary defect closure site. Epub 2015 Mar 28. Subcutaneous tissue, and even muscle situated under it, can be rotated with the skin. By continuing you agree to the use of cookies. Technique for use of external tissue expansion for reconstruction of head and face defects. Results. It is possible to plan four available rhomboids on the 120° angles. Closure of defects with this approach is easy to visualize since the 2 : 1 parallelogram consists of two 60° rhombi (Fig.