What Is Transpositional Flap Surgery?

Transpositional flaps in plastic surgery refer to cutouts of healthy skin or other tissue. The surgeon then rotates the still-attached tissue to cover an adjacent injury or defect.

Flaps are skin and subcutaneous tissue with an intact blood supply moved to cover an adjacent tissue defect. They are used in reconstructive surgery (usually performed by plastic surgeons). The kind tissue injury or defect the surgeon aims to correct determines which of three different techniques they use 

• advancement flaps, 
• rotational flaps or 
• transposition flaps.

Many variations and modifications of transposition flaps exist. Similar to other flaps, transposition flaps may be further modified and adjusted to accommodate individual situations.

Transpositional flap surgery is a reconstructive surgery which uses transposition flaps. A transposition flap is a flap rotated to cover an intervening area of normal skin to be placed in its recipient site. 

Transpositional flaps exploit skin elasticity at a site distant to the surgical defect and redirect the tension of closure, meaning the sutures or other closure techniques don’t pull the wound together at a weak part in the tissue. They are generally smaller and move more freely and are common in facial reconstruction.

Rotation flaps are flaps in which the tissue is rotated on a pivot point to cover a primary defect. Rotation flaps fill one defect by creating another defect that may be closed with less tension.

This reconstructive surgery uses flaps that involve advancement of adjacent tissue to cover a primary tissue defect.

Transpositional flap surgery

• Accomplishes redistribution and redirection of tension.
• Tends to use smaller areas of tissue than advancement and rotation flaps.
• Results in more aesthetically pleasing scars that tend to be easy to hide.

Many different types of transposition flaps exist, though the most used types include the following:

• Classic rhombic flap to cover rhombus-shaped defects
• Modified rhombic flaps to close defects with acute angles 
• Banner-type flaps for closure of postsurgical defects of the nasal dorsum
• Tunneled transposition flap for closure of wide defects and preserving aesthetic appearance 

Transpositional flap surgery may not be an option for people who

• Smoke
• Take aspirin or other anticoagulant medication
• Have systemic health conditions

• Dehiscence: A cut made during the procedure separates or ruptures after it has been sutured.
• Flap necrosis (tissue death) due to excessive tension or postoperative infection
• Pincushioning, or the trapdoor phenomenon: The puffing up or out-pouching of a flap above the surrounding skin surface. Pincushioning may occur because of 
  • excess subcutaneous fat under the flap, 
  • fluid accumulation, 
  • oversized flaps, or 
  • a failure to establish contact between the undersurface of the flap and the recipient bed (lack of contact inhibition), which pushes up the flap center.