Overview of Mohs Micrographic Surgery Design and Execution of Rotation Flaps
Mohs micrographic surgery is a special technique used to remove skin cancers, which plays a key role when performing surgery in sensitive body areas like the head and neck. This is particularly true for delicate tissues, such as the lip or eyelid, which can be easily reshaped during the fixing of even small defects. If a straightforward closure isn’t possible, using a surgical “flap” (a piece of tissue that is partly detached and used to cover a nearby wound) comes in handy.
Depending on the size and location of the defect, and the flexibility of the skin near the defect, a surgical “rotational flap” may be used. This flap is a piece of skin that is rotated into place to cover a wound or defect and can help achieve the best outcomes in looks as well as functionality after Mohs surgery.
Successfully planning and implementing a surgical flap involves consideration of the specific body structure involved because it involves moving tissues close to the repair site. The patient’s satisfaction largely depends on how they look after surgery; a well-designed and implemented flap can enhance the appearance and functionality of the repaired site.
Anatomy and Physiology of Mohs Micrographic Surgery Design and Execution of Rotation Flaps
If a doctor is planning a particular kind of surgery involving making a surgical flap – moving a piece of tissue from one area to another – they need to be very familiar with the parts of the body that will be involved, such as the muscles, nerves, and blood vessels. It’s particularly important for the doctor to know where the blood vessels are, as this helps make sure that the new flap of tissue will get enough blood supply to stay healthy.
There are two main types of surgical flaps – those that rely on a specific artery for blood supply, and those which get blood from numerous small, deeper arteries and don’t rely on a particular one. When a ‘rotational surgical flap’ is created, it falls into the second category, as it doesn’t rely on a specific artery for blood supply but several ones instead. This kind of surgery can be quite complex, and requires a good understanding of how blood flows in the body.
Why do People Need Mohs Micrographic Surgery Design and Execution of Rotation Flaps
Rotational surgical flaps are primarily used when a straight-line closure would not give the best appearance or functional result. In this form of surgery, extra skin nearby is moved to fill in the area which needs to be repaired. As a result, the skin fits better and looks more natural. This technique is often chosen based on a surgeon’s specific skills and experience.
The unique feature of rotational flaps is their curved shape, allowing them to be moved like a pivot rather than in a straight line. This rotational movement reduces tension from the area being treated and spreads it across the length of the flap. This is particularly ideal for defects shaped like a triangle because the flap’s curved end covers the other end asymmetrically.
Because rotational flaps have only two edges, the surgical stitches can be easily hidden within the skin’s existing lines of tension. In contrast, the rhomboid flap, another type of skin flap, has four edges that must be stitched. Therefore, a rotational flap is more likely to provide a better visual result with stitches that blend more naturally into the surrounding skin.
These flaps can be used to repair defects in non-facial areas and major facial areas like the cheek, temple, and scalp. Experienced surgeons can also use them on delicate areas like the nose or eyelid. For instance, the dorsal nasal rotation flap is a specialized rotation flap that can repair defects on the nose’s upper surface for carefully selected patients. This technique has consistently provided satisfactory appearance and functional outcomes.
There are other specialized rotational flaps like the Mustarde and Tenzel flaps which are used when repairing defects near the eye. The classic Mustarde flap uses the looseness of the cheek and temple skin to cover a defect involving the lower eyelid. On the other hand, the classic Tenzel flap repairs defects on the lower eyelid by using tissue from around the eye and temple.
When a Person Should Avoid Mohs Micrographic Surgery Design and Execution of Rotation Flaps
In certain parts of the head and neck, it’s not ideal to use a specific type of surgical procedure known as a ‘rotational flap repair.’ This is because the process requires long cut lines to permit enough movement of the skin flap and to reduce the tension of the wound.
How is Mohs Micrographic Surgery Design and Execution of Rotation Flaps performed
Performing any kind of skin grafting surgery requires a high level of skill, knowledge, and a deep understanding of surgical techniques. One of the most important aspects of rotational skin grafts, which involve rotating a flap of skin from one area to another, is positioning the flap in a way that it can easily be moved to its new position.
This usually involves making a long, curved incision in the pattern of an arc. This process is designed to reduce the stress of closing the wound. But it’s crucial to ensure the incision isn’t too long because if the length of the skin ‘pedicle’ (the flap’s root) is far longer than its base, it might not get enough blood supply, which can impact the success of the graft.
After cutting the skin flap, it’s essential to carefully loosen the surrounding tissues to alleviate potential movement restrictions. Naturally, there might be some residual stress where the flap pivots. That’s why it’s essential to measure the flap correctly: if it’s too small, it might end up pulling too tight at the edge. To counteract this, the flap can be made slightly larger and extended a bit further above the wound. This helps reduce stress, minimize tension, and prevent the need for more tissue movement around the wound.
In some cases, where the skin doesn’t move much, such as the scalp, a secondary cut might be helpful to improve the flexibility of the skin flap. However, this additional cut can interfere with the blood supply to the flap, increasing the chances that the graft might not be successful.
Possible Complications of Mohs Micrographic Surgery Design and Execution of Rotation Flaps
Procedures that involve breaking the skin’s protective layer can sometimes have complications like infection, scarring, and bleeding. Bleeding is most common in a type of skin cancer surgery called Mohs micrographic surgery when using a ‘rotational flap’ procedure.
Bleeding during and after surgery can be managed in several ways. One method is the use of lidocaine with epinephrine, which is a drug that restricts the blood vessels and helps decrease bleeding during surgery. Tools that use electricity such as ‘electrocautery’, ‘electrocoagulation’, and ‘electrofulguration’ also help to stop bleeding during surgery. If doctors expect bleeding after surgery, they might use pressure dressings or a wound drain, which also helps prevent a mass of usually clotted blood from forming that might interfere with the healing of the ‘flap’ (skin piece). It’s also worth noting that patients who are using blood-thinning medication should continue taking it to avoid the risk of blood clots, despite any possible increase in bleeding during or after surgery.
Many problems with ‘rotational flaps’ originate from poor design. If the circular area around the surgical wound is too small, this puts too much tension on the ‘flap’, especially at the distant tip. This excess tension increases the chances of reduced blood supply and unintended changes in the surrounding tissues, leading to distortion. On the other hand, if this circular area is much longer than the ‘flap’ width, it may decrease blood supply to the ‘flap’s distant tip, which could also lead to inadequate blood supply.
What Else Should I Know About Mohs Micrographic Surgery Design and Execution of Rotation Flaps?
Mohs micrographic surgery, a precise skin cancer treatment, is typically used on areas of the body with limited skin flexibility, such as the lips, nose, cheeks, and forehead. In these areas, directly stitching up the wound after surgery can lead to a distorted appearance because the skin doesn’t stretch easily.
Advanced flap techniques, where skin is moved around to cover the wound, are used instead when a simple stitch-up can’t be done. This approach is particularly important for treating irregularly shaped wounds, ensuring a more desirable healing process.
The guidelines for deciding when to use Mohs surgery were created in 2012, with input from top skin health organizations like the American College of Mohs Surgery. These rules provide a thorough examination of factors including the type of tumor, the size of the tumor, and its location.
These guidelines tend to favor using Mohs surgery in areas where the skin doesn’t stretch much, mostly on the face and neck. Areas with less flexible skin may not be suitable for direct stitch-up after the tumor removal, highlighting the need for advanced skin closure methods, such as the flap technique.
