Exactly what is flap surgery???

Obieone · 02-10-2004, 03:05 PM

Can someone describe for me the procedure and what one can expect as far as recovery time from this surgery? Bill is having two flaps done: one on his belly to cover an abdominal wound from his tummy surgery and a pressue sore(crater

) on his butt crease (ischical sp)! Sure would ease some anxiety knowing what to expect?
Thanks
Obie

Wise Young · 02-10-2004, 04:44 PM

Obie, I can take a shot at your question but other people should chime in.

A flap is a surgical procedure where a piece of skin or other organ is transposed from one site to another site with the vascular source intact. This is frequently called a pedicled flap. In other words, you would tranfer a piece of tissue along with its vasculature so that it remains well fed by blood. In general, flaps refer to skin.

I am not exactly sure from your description what flap is being done to what. It sounds as if they will be moving a piece of skin from the belly and they will be using a flap to cover that opening. Part of the problem of doing a pedicle clap on the hind end is that one does not have all that much spare skin and vasculature on the hind end, compared to the abdomen. The front side has a lot more vasculature than the hind side. It sounds as if they will be moving a piece of skin from the abdomen to the pressure sore, doing a pedicled flap to cover the abdomenal area. Abdomenal skin also has some fat padding and that would be good.

Wise.

lynnifer · 02-10-2004, 06:59 PM

I had a flap done on my derriere at age 15 (age 31 now). It was to close a pressure sore in the coccix area. Part of my tailbone had become infected and had to be removed. The flap surgery was a success, although it tied me up in bed on my side for three months (hospitalized all that time).. missed a couple of months of school out of the deal.

Never another problem on the rump, but I also changed from a standard foam pad to a Jay Active cushion.

The heels of my feet are another story.

Signed the Pressure Sore Queen!

SCI-Nurse · 02-10-2004, 07:40 PM

Obieone - Has your husband been seen by an infectious disease specialist? Often times in very deep decubitus ulcers, there are infections that have inhibited healing. It would be important for this to be assessed. CRF

SCI-Nurse · 02-10-2004, 07:51 PM

Here are some photos of a myocutaneous flap done for a sacral pressure ulcer. WARNING: THESE ARE GRAPHIC INTRAOPERATIVE PHOTOS:

Myocutaneous flap

The principles are the same for rectus muscle flaps for abdominal wound defects and for ischial pressure ulcer flaps (which are often done with the posterior thigh muscles).

(KLD)

Obieone · 02-10-2004, 09:37 PM

Thank you all so much for the replies.We have been consulting with wound care specialists all along and they are an integral part of the team.Also we have purchased an alternating pressure mattress from KCI so it will go where Bill goes forever now

!

I've always believed knowledge is power.

Thanks again.
Obie

monkeygirl · 02-11-2004, 12:29 AM

Quote:

Originally posted by SCI-Nurse:

Here are some photos of a myocutaneous flap done for a sacral pressure ulcer. _WARNING: THESE ARE GRAPHIC INTRAOPERATIVE PHOTOS
(KLD)

OMG KLD!, Again, I wonder how you guys do what you do, I couldn't even look at the rest of the page. I just wanted to say thanks again for what you all do, you really are "Angels"(Sent by God,... )(lol) I think of all of you when Monica says that on "Touched by an Angel"

Anywho, Thanx for doing what so many of us could never do, (99.99%), we'd be lost without you guys!

PS: Obie, hope all goes well with Bill, sounds like you're in good hands.

Sue Pendleton · 02-11-2004, 08:37 AM

Lynnifer, I have a friend that had open sores on his heels for over a year. After his plastic surgeon quit laughing at the idea of pig skin heels....he collected all the information on the following. My friend's heels healed so rapidly compared to normal wound care of that area that his surgeon was making house calls to take pictures on a weekly basis. This stuff is not for every kind of sore but has saved a lot of graft surgery.
http://news.uns.purdue.edu/html4ever...dylak.SIS.html

Courage doesn't always roar. Sometimes courage is the quiet voice at the end of the day saying, "I will try again tomorrow."

smokey · 02-11-2004, 01:24 PM

obieone, I had an advancement flap procedure done in 1983 on my ischium and it has held up very well. I'm much more careful now and mindful of the danger signs and situations. The plastic surgeon basically excised the pressure ulcer, cut and shifted a large-vascularized chunk of tissue from the back of my thigh up to the butt cheek area and stitched it into place. It left about a 2"x3" hole under my thigh area, but it is not in an area known for pressure problems. I think I laid around for 8 weeks until it healed. Well worth it.

SCI-Nurse · 02-11-2004, 05:42 PM

Sue - thanks for sharing that very interesting research and outcomes. Since the article is almost 4 years old, I wonder how much more success they have had and whether it is being used frequently. It certainly seems to be a valuable options that needs to be explored for persons with very serious decubiti. CRF

02-10-2004, 03:05 PM	#1
Obieone Moderator Join Date: Aug 2001 Location: Manitoba,Canada Posts: 5,609	Exactly what is flap surgery??? Can someone describe for me the procedure and what one can expect as far as recovery time from this surgery? Bill is having two flaps done: one on his belly to cover an abdominal wound from his tummy surgery and a pressue sore(crater ) on his butt crease (ischical sp)! Sure would ease some anxiety knowing what to expect? Thanks Obie

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02-10-2004, 04:44 PM	#2
Wise Young Administrator Join Date: Jul 2001 Location: New Brunswick, NJ, USA Posts: 37,988	Obie, I can take a shot at your question but other people should chime in. A flap is a surgical procedure where a piece of skin or other organ is transposed from one site to another site with the vascular source intact. This is frequently called a pedicled flap. In other words, you would tranfer a piece of tissue along with its vasculature so that it remains well fed by blood. In general, flaps refer to skin. I am not exactly sure from your description what flap is being done to what. It sounds as if they will be moving a piece of skin from the belly and they will be using a flap to cover that opening. Part of the problem of doing a pedicle clap on the hind end is that one does not have all that much spare skin and vasculature on the hind end, compared to the abdomen. The front side has a lot more vasculature than the hind side. It sounds as if they will be moving a piece of skin from the abdomen to the pressure sore, doing a pedicled flap to cover the abdomenal area. Abdomenal skin also has some fat padding and that would be good. Wise.

02-10-2004, 06:59 PM	#3
lynnifer Senior Member Join Date: Aug 2002 Location: Windsor ON Canada Posts: 15,443	I had a flap done on my derriere at age 15 (age 31 now). It was to close a pressure sore in the coccix area. Part of my tailbone had become infected and had to be removed. The flap surgery was a success, although it tied me up in bed on my side for three months (hospitalized all that time).. missed a couple of months of school out of the deal. Never another problem on the rump, but I also changed from a standard foam pad to a Jay Active cushion. The heels of my feet are another story. Signed the Pressure Sore Queen!

02-10-2004, 07:40 PM	#4
SCI-Nurse Moderator Join Date: Jul 2001 Location: USA Posts: 41,523	Obieone - Has your husband been seen by an infectious disease specialist? Often times in very deep decubitus ulcers, there are infections that have inhibited healing. It would be important for this to be assessed. CRF

02-10-2004, 07:51 PM	#5
SCI-Nurse Moderator Join Date: Jul 2001 Location: USA Posts: 41,523	Here are some photos of a myocutaneous flap done for a sacral pressure ulcer. WARNING: THESE ARE GRAPHIC INTRAOPERATIVE PHOTOS: Myocutaneous flap The principles are the same for rectus muscle flaps for abdominal wound defects and for ischial pressure ulcer flaps (which are often done with the posterior thigh muscles). (KLD)

02-10-2004, 09:37 PM	#6
Obieone Moderator Join Date: Aug 2001 Location: Manitoba,Canada Posts: 5,609	Thank you all so much for the replies.We have been consulting with wound care specialists all along and they are an integral part of the team.Also we have purchased an alternating pressure mattress from KCI so it will go where Bill goes forever now ! I've always believed knowledge is power. Thanks again. Obie

02-11-2004, 08:37 AM	#8
Sue Pendleton Moderator Join Date: Jul 2001 Location: Wisconsin USA Posts: 9,172	Lynnifer, I have a friend that had open sores on his heels for over a year. After his plastic surgeon quit laughing at the idea of pig skin heels....he collected all the information on the following. My friend's heels healed so rapidly compared to normal wound care of that area that his surgeon was making house calls to take pictures on a weekly basis. This stuff is not for every kind of sore but has saved a lot of graft surgery. http://news.uns.purdue.edu/html4ever...dylak.SIS.html Courage doesn't always roar. Sometimes courage is the quiet voice at the end of the day saying, "I will try again tomorrow."

02-11-2004, 01:24 PM	#9
smokey Senior Member Join Date: Jul 2001 Location: Massachusetts, USA Posts: 1,868	obieone, I had an advancement flap procedure done in 1983 on my ischium and it has held up very well. I'm much more careful now and mindful of the danger signs and situations. The plastic surgeon basically excised the pressure ulcer, cut and shifted a large-vascularized chunk of tissue from the back of my thigh up to the butt cheek area and stitched it into place. It left about a 2"x3" hole under my thigh area, but it is not in an area known for pressure problems. I think I laid around for 8 weeks until it healed. Well worth it.

02-11-2004, 05:42 PM	#10
SCI-Nurse Moderator Join Date: Jul 2001 Location: USA Posts: 41,523	Sue - thanks for sharing that very interesting research and outcomes. Since the article is almost 4 years old, I wonder how much more success they have had and whether it is being used frequently. It certainly seems to be a valuable options that needs to be explored for persons with very serious decubiti. CRF