|Microsurgery: Transplantation and Replantation by Harry J. Buncke, MD, et al.|
| When cutaneous flap transplantation is being considered, preoperative angiography is used to delineate the potential recipient vasculature when its integrity is in question. In patients with easily palpable recipient vessels and no previous trauma or surgery, angiography is not necessary.
Preparation of the recipient region for a cutaneous free flap entails defining the extent of the true defect, obtaining a pattern of the defect, and dissecting the recipient vasculature and sensory nerve.
The location of the defect may influence the choice of the flap because it dictates the position in which the patient must be placed on the operating table. Simultaneous dissection of both recipient and donor areas can be accomplished only if both areas are accessible at the same time. When a specific flap is required, separate dissections may have to be performed, necessitating changing the position of the patient and redraping for each dissection. The recipient area is prepared first to be certain that there are adequate recipient vessels and to decrease the ischemia time of the transplant once it is isolated. In fact, three position changes may be required: one to evaluate and prepare the recipient site, the second to gain access to the donor area for delivery of the flap and closure of the donor area, and the third to reapproach the recipient site for the inset of the transplant. With infected wounds, several complete setups may be necessary to prevent
| cross-contamination. The experience of the surgical teams with various types of flaps and the desires of the patient may also play an important role in the choice of donor flap.
Cutaneous flaps may be used for coverage with or without innervation to restore cover and contour, or as a dermofat graft to restore contour alone.
The major advantage of the groin flap is its inconspicuous linear donor-defect scar. Unfortunately, its vascular pedicle is short and anatomically inconsistent, a drawback that has led to the development of many new free flaps with vascular pedicles of larger caliber and longer length. It is a poor donor area in obese individuals. Secondary thinning by liposuction, however, can produce dramatic results (see Chapter 7). Even so, the groin flap has been and still is used to reconstruct defects of the head, neck, chest, and upper and lower extremities to provide durable coverage and restore contour defects.
When used to reconstruct defects of the lower extremity, the groin flap generally provides excellent color and skin texture match as well as satisfactory restoration of contour. Occasionally, Z-plasties must be incorporated into the scar that circumscribes the flap to minimize the trap-door or powder-puff effect and maximize contour restoration.
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