Abstract
Background
Contraction in a skin flap is unavoidable after it is raised because of its elastic content and despite the best of planning a flap may fall short which may lead to some necrosis. This study was conducted to ascertain the extent of contraction of flaps and the factors that might influence this contraction.
Methods
This prospective study included 25 patients who underwent reconstructions of defects with different types of skin and fascio-cutaneous (FC) flaps. Clinical data including age; sex; body mass index; site/type of flap; and the flap’s surface area, thickness, and its contraction in relation with the relaxed skin tension lines (RSTL) were recorded and analyzed. The outcome of the success or failure of the flap was ascertained by clinical examination.
Results
There were 20 males and 5 female patients and their age ranged from 10 to 67 years. Mean flap contraction was 20.01% in skin flaps and 20.38% in FC flaps; overall mean contraction was 20.19%. Flaps retracted more when constructed parallel to RSTL, in females and in patients with high BMI. Age did not affect the contraction.
Conclusions
Skin flaps can be stretched to a certain extent, but not up to pre-flap area without compromising the blood supply. Therefore, adequate allowance should be provided to avoid stretching, and subsequent necrosis and dehiscence. The most practical way of providing this allowance is by planning in reverse which flap size is always bigger than the defect, therefore providing margins for flap contraction.
Level of evidence
Level IV, risk/prognostic study
Similar content being viewed by others
References
Crawford BS (1965) The management of tube pedicles. Br J Plast Surg 18:387–396
Saad MN (1970) The problem of traumatic skin loss of the lower limbs especially when associated with skeletal injury. Br J Surg 67:601–615
McGregor IA, Morgan G (1973) Axial and random pattern flaps. Br J Plast Surg 26:202–213
Samhita S (1907) An English translation of the Sushruta Samhita (English translation by Kaviraj Kunja Lal Bhishagratna). Calcutta, West Bengal, India: the Bharat Mihir Press
Gillies HD (1920) Plastic surgery of the face based on selected cases of war injuries of the face including burns, with original illustrations. Oxford Medical Publications, London
Davis JS (1946) Plastic surgery in World War I and in World War II. Plast Reconstr Surg 1:255–264
Santoni-Rugiu P, Sykes PJ (2007) A history of plastic surgery. Springer, Berlin
Morrison EJ, Morrison AJ (2015) Basic skin flaps and blood supply. In Farhadieh RD, Neil W. Bulstrode NW, Cugno S. (Eds) Plastic and reconstructive surgery: approaches and techniques; John Wiley & Sons, Ltd. pp 12–21
Langer K (1978) On the anatomy and physiology of the skin I. The cleavability of the cutis. Br J Plast Surg 31:3–8
Stark HL (1977) Directional variations in the extensibility of human skin. Br J Plast Surg 30:105–114
Edwards C, Marks R (1995) Evaluation of biomechanical properties of human skin. Clin Dermatol 13:375–380
Stell PM, Green JR.(1976) Contraction of the delto-pectoral flap. Clinical observations and the design of an experimental model. Acta Otolaringol 81:181–86
Rose EH, Ksander GA, Vistnes LM (1976) Skin tension lines in the domestic pig. Plast Reconstr Surg 57:729–732
Stell PM (1982) Contraction of skin flaps. Clin Otolaryngol 7:45–49
Larrabee WF Jr, Holloway GA Jr, Sutton D (1984) Wound tension and blood flow in skin flaps. Ann Otol Rhinol Laryngol 93:112–115
Patterson TJS (1971)The effect of tension on the survival of skin flaps. Trans 5th Intl Cong Plast Reconstr Surg. Butterworth, Australia
Stell PM (1980) The effects of varying degrees of tension on the viability of skin flaps in pigs. Br J Plast Surg 33:371–376
Stell PM (1979) Effect of age on the retraction of skin. Gerontology 25:145–150
Lim KH, Jeyapalina S, Ho HN, Chew CM, Chen PC, Teo CL, Lim BH (2008) Non-invasive prediction of skin flap shrinkage: a new concept based on animal experimental evidence. J Biomech 41:1668–1674
Cox HT (1941) The cleavage lines of the skin. Br J Surg 29:234–240
McGregor I, Jackson IT (1970) The extended role of the delto-pectoral flap. Br J Plast Surg 23:173–185
Ng RW, Chan JY, Mok V, Leung MS, Yuen AP, Wei WI (2008) Clinical implications of anterolateral thigh flap shrinkage. Laryngoscope 118:585–588
Barron JN, Emmeta JJ (1965) Subcutaneous pedicle flaps. Br J Plast Surg 5:171–180
Thomas JR (2010) Advanced therapy in facial plastic and reconstructive surgery (Eds) Malley JO, Wonsiewicz CC. USA Shelton Connecticut: People’s medical publishing house
Rudolph R, Ballantyne D (1990) Plastic surgery. Saunders, Philadelphia, pp 221–274
Ragnell A (1952) The secondary contracting tendency of free skin grafts; an experimental investigation on animals. Br J Plast Surg 5:6–24
Corps BV (1969) The effect of graft thickness, donor site and graft bed on graft shrinkage in the hooded rat. Br J Plast Surg 22:125–133
Davis JS, Kitlowski EA (1931) The immediate contraction of cutaneous grafts and its cause. Arch Surg 23:954–965
Berezovsky AB, Pagkalos VA, Silberstein E, Shoham Y, Rosenberg L, Krieger Y (2015) Primary contraction of skin grafts: a porcine preliminary study. Plast Aesthet Res 2:22–26
Fawcett DW (1986) A textbook of histology, eleventh ed. W.B. Saunders Company, Philadelphia
Rudolph R (1982) Complications of surgery for radiotherapy skin damage. Plast Reconstr Surg 70:179–185
Gong X, Cui J, Jiang Z, Lu L, Li X (2018) Risk factors for pedicled flap necrosis in hand soft tissue reconstruction: a multivariate logistic regression analysis. ANZ J Surg 88(3):E127–E131
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
Pawan Agarwal, Prachir Mukati, and D. Sharma declare that they have no conflict of interest.
Ethical approval
Institutional ethical committee approval taken.
Patient consent
Obtained from patients and their parents in case of minors.
Additional information
Publisher’s note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
About this article
Cite this article
Agarwal, P., Mukati, P. & Sharma, D. Contraction of skin flaps: re-examining the scientific basis. Eur J Plast Surg 43, 453–458 (2020). https://doi.org/10.1007/s00238-020-01630-2
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00238-020-01630-2