eMedicine Specialties > Dermatology > Surgical

Transposition Flaps: Follow-up

Author: Vandana Chatrath, MD, Consultant in Dermatology, Delhi Dermatology Group, India
Coauthor(s): Thomas Rohrer, MD, Director of Dermatologic Surgery, Associate Professor; Department of Dermatology, Boston University School of Medicine
Contributor Information and Disclosures

Updated: Feb 26, 2009

Outcome and Prognosis

In conclusion, many variations and modifications of transposition flaps exist. Similar to other flaps, transposition flaps may be further modified and adjusted to accommodate individual situations. They may be lengthened or shortened, and their angles may be altered depending upon the availability and laxity of surrounding skin.

Future and Controversies

No single flap can be used to reconstruct all defects. Each patient must be treated with a unique strategy. A 2-dimensional picture of a given defect may seem to indicate a certain type of repair. This may or may not be the optimal repair for that given patient. Only by feeling the skin in the area around the defect may the best option for repair be determined.

Transposition flaps dissipate tension away from the flap apex and distribute it proximally, thus redirecting the tension lines and reducing the likelihood of anatomic distortion in the reconstructed area; this is a major advantage offered by the use of these types of flaps. Flaps designed in this manner allow improved contour by avoiding webbing, tenting across concavities, and bunching of skin laterally.

A significant degree of artistic ability and individual modification is required to consistently obtain optimal aesthetic and functional result.

 


More on Transposition Flaps

Overview: Transposition Flaps
Treatment: Transposition Flaps
Follow-up: Transposition Flaps
Multimedia: Transposition Flaps
References
[ CLOSE WINDOW ]

References

  1. Borges AF. The rhombic flap. Plast Reconstr Surg. Apr 1981;67(4):458-66. [Medline].

  2. Bray DA. Clinical applications of the rhomboid flap. Arch Otolaryngol. Jan 1983;109(1):37-42. [Medline].

  3. Fee WE Jr, Gunter JP, Carder HM. Rhomboid flap principles and common variations. Laryngoscope. Nov 1976;86(11):1706-11. [Medline].

  4. Larrabee WF Jr, Trachy R, Sutton D, Cox K. Rhomboid flap dynamics. Arch Otolaryngol. Dec 1981;107(12):755-7. [Medline].

  5. Masson JK, Mendelson BC. The banner flap. Am J Surg. Sep 1977;134(3):419-23. [Medline].

  6. Fortier-Riberdy G, Gloster HM. Reconstruction of the superior helical rim with a postauricular transposition flap. Dermatol Surg. Jan 2005;31(1):99-101. [Medline].

  7. Aasi SZ, Leffell DJ. Bilobed transposition flap. Dermatol Clin. Jan 2005;23(1):55-64, vi. [Medline].

  8. Cook JL. Reconstructive utility of the bilobed flap: lessons from flap successes and failures. Dermatol Surg. Aug 2005;31(8 Pt 2):1024-33. [Medline].

  9. McGregor JC, Soutar DS. A critical assessment of the bilobed flap. Br J Plast Surg. Apr 1981;34(2):197-205. [Medline].

  10. Morgan BL, Samiian MR. Advantages of the bilobed flap for closure of small defects of the face. Plast Reconstr Surg. Jul 1973;52(1):35-7. [Medline].

  11. Ricks M, Cook J. Extranasal applications of the bilobed flap. Dermatol Surg. Aug 2005;31(8 Pt 1):941-8. [Medline].

  12. Zitelli JA. The bilobed flap for nasal reconstruction. Arch Dermatol. Jul 1989;125(7):957-9. [Medline].

  13. Webster RC, Davidson TM, Smith RC. The thirty degree transposition flap. Laryngoscope. Jan 1978;88(1 Pt 1):85-94. [Medline].

  14. Lister GD, Gibson T. Closure of rhomboid skin defects: the flaps of Limberg and Dufourmentel. Br J Plast Surg. Jul 1972;25(3):300-14. [Medline].

  15. Hairston BR, Nguyen TH. Innovations in the island pedicle flap for cutaneous facial reconstruction. Dermatol Surg. Apr 2003;29(4):378-85. [Medline].

  16. Borges AF. Choosing the correct Limberg flap. Plast Reconstr Surg. Oct 1978;62(4):542-5. [Medline].

  17. Brobyn TJ, Cramer LM, Hulnick SJ, Kodsi MS. Facial resurfacing with the Limberg flap. Clin Plast Surg. Jul 1976;3(3):481-90. [Medline].

  18. Jun-Hui L, Xin X, Tian-Xiang O. Subcutaneous Pedicle Limberg Flap for Facial Reconstruction. Dermatol Surg. 2005;31:949-952.

  19. Koranda FC, Webster RC. Trapdoor effect in nasolabial flaps. Causes and corrections. Arch Otolaryngol. Jul 1985;111(7):421-4. [Medline].

  20. Webster RC, Benjamin BJ, Smith RC. Treatment of "trap door deformity.". Laryngoscope. Apr 1978;88(4):707-12. [Medline].

  21. Rotunda AM, Bennett RG. Nasal tip wound repair using a rhombic transposition flap with a double Z-plasty at its base. Dermatol Surg. 2006;32:945-947.

  22. Bauer BS, Margulis A. The expanded transposition flap: shifting paradigms based on experience gained from two decades of pediatric tissue expansion. Plast Reconstr Surg. Jul 2004;114(1):98-106. [Medline].

  23. Converse JM, ed. Reconstructive Plastic Surgery: General Principles. 2nd ed. Philadelphia, Pa: WB Saunders; 1977:202-7.

  24. Davidson TM, Webster RC, Gordon BR. The Principles and Dynamics of Local Skin Flaps. Chicago, Ill: American Academy of Otolaryngology Head and Neck Surgery; 1983.

  25. Dzubow LM. The dynamics of flap movement: effect of pivotal restraint on flap rotation and transposition. J Dermatol Surg Oncol. Dec 1987;13(12):1348-53. [Medline].

  26. Grabb WC, Myers MB, eds. Skin Flaps. Boston, Mass: Little Brown & Company; 1975:111-31.

  27. Krishnan RS, Clark DP, Donnelly HB. Tunneled transposition flap for reconstruction of defects of the nasal ala. Dermatol Surg. Dec 2007;33(12):1496-501. [Medline].

  28. Limberg AA. Design of local flaps. In: Gibson T, ed. Modern Trends of Plastic Surgery. London, England: Butterworth-Heinemann; 1966:38-61.

  29. Rohrer TE, Bhatia A. Transposition flaps in cutaneous surgery. Dermatol Surg. Aug 2005;31(8 Pt 2):1014-23. [Medline].

  30. Rossi A, Jeffs JV. The rhomboid flap of Limberg--a simple aid to planning. Ann Plast Surg. Dec 1980;5(6):494-6. [Medline].

  31. Webster RC, Benjamin BJ, Smith RC. Closure of circular defects. Laryngoscope. Mar 1978;88(3):534-8. [Medline].

  32. Yanai A, Ueda K, Takato T. Flexible rhombic flap. Plast Reconstr Surg. Aug 1986;78(2):228-35. [Medline].

  33. Yotsuyanagi T, Yamashita K, Urushidate S, et al. Reconstruction of large nasal defects with a combination of local flaps based on the aesthetic subunit principle. Plast Reconstr Surg. May 2001;107(6):1358-62. [Medline].

[ CLOSE WINDOW ]

Further Reading

[ CLOSE WINDOW ]

Keywords

transposition flaps, facial reconstruction, repairing defects with transposition flaps, bilobed flaps, rhombic flaps, rhomboid flaps, Dufourmentel flaps, banner-type flaps, nasolabial transposition flaps, island pedicle flaps, transposition island pedicle flaps, Webster flaps

[ CLOSE WINDOW ]

Contributor Information and Disclosures

Author

Vandana Chatrath, MD, Consultant in Dermatology, Delhi Dermatology Group, India
Disclosure: Nothing to disclose.

Coauthor(s)

Thomas Rohrer, MD, Director of Dermatologic Surgery, Associate Professor; Department of Dermatology, Boston University School of Medicine
Thomas Rohrer, MD is a member of the following medical societies: American Academy of Dermatology, American College of Mohs Micrographic Surgery and Cutaneous Oncology, American Society for Dermatologic Surgery, and American Society for Laser Medicine and Surgery
Disclosure: Nothing to disclose.

Medical Editor

Désirée Ratner, MD, Director of Dermatologic Surgery, Professor of Clinical Dermatology, Department of Dermatology, Columbia University Medical Center, New York Presbyterian Hospital
Désirée Ratner, MD is a member of the following medical societies: American Academy of Dermatology, American College of Mohs Micrographic Surgery and Cutaneous Oncology, American Medical Association, American Society for Dermatologic Surgery, and Phi Beta Kappa
Disclosure: Nothing to disclose.

Pharmacy Editor

David F Butler, MD, Professor of Dermatology, Texas A&M University College of Medicine; Chair, Department of Dermatology, Director, Dermatology Residency Training Program, Scott and White Clinic, Northside Clinic
David F Butler, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American Medical Association, American Society for Dermatologic Surgery, American Society for MOHS Surgery, Association of Military Dermatologists, and Phi Beta Kappa
Disclosure: Nothing to disclose.

Managing Editor

John G Albertini, MD, Consulting Staff, Dermatologic Surgery, The Skin Surgery Center; Program Director, ACGME accredited Fellowship in Procedural Dermatology
John G Albertini, MD is a member of the following medical societies: American Academy of Dermatology and American College of Mohs Micrographic Surgery and Cutaneous Oncology
Disclosure: Nothing to disclose.

CME Editor

Catherine M Quirk, MD, Clinical Assistant Professor, Department of Dermatology, University of Pennsylvania
Catherine M Quirk, MD is a member of the following medical societies: Alpha Omega Alpha and American Academy of Dermatology
Disclosure: Nothing to disclose.

Chief Editor

Dirk M Elston, MD, Director, Department of Dermatology, Geisinger Medical Center
Dirk M Elston, MD is a member of the following medical societies: American Academy of Dermatology
Disclosure: Nothing to disclose.

 
 
HONcode

We subscribe to the
HONcode principles of the
Health On the Net Foundation

All material on this website is protected by copyright, Copyright© 1994- by Medscape.
This website also contains material copyrighted by 3rd parties.

DISCLAIMER: The content of this Website is not influenced by sponsors. The site is designed primarily for use by qualified physicians and other medical professionals. The information contained herein should NOT be used as a substitute for the advice of an appropriately qualified and licensed physician or other health care provider. The information provided here is for educational and informational purposes only. In no way should it be considered as offering medical advice. Please check with a physician if you suspect you are ill.