Plastic surgery; its principles and practice . pedunculated flaps. If the pedicle of a flap adjacent to the defect is too short to allowturning into the defect without tension, the incision not terminatingin the defect should be prolonged outward (Fig. no). A pedicle should never be notched at the time of implantation in 124 PLASTIC SURGERY order to make it fit better, as there is risk of impairing the there is puckering of the edges of a pedicle, it can be adjusted afterthe new circulation is assured. Twdsting or too much tension on a pedicle may cause shutting offof the circul
Plastic surgery; its principles and practice . pedunculated flaps. If the pedicle of a flap adjacent to the defect is too short to allowturning into the defect without tension, the incision not terminatingin the defect should be prolonged outward (Fig. no). A pedicle should never be notched at the time of implantation in 124 PLASTIC SURGERY order to make it fit better, as there is risk of impairing the there is puckering of the edges of a pedicle, it can be adjusted afterthe new circulation is assured. Twdsting or too much tension on a pedicle may cause shutting offof the circulation and gangrene of the flap. Occasionally gangrene occurs in a flap which has an excellent bloodsupply; this may be due to lack of drainage from the flap, or in otherwords the flap is choked with the blood and lymph that enter it, but areunable to get out promptly. This accident is especially to be fearedif the pedicle contains a main artery. To overcome this danger C. suggested superficial scarification of the flap to allow surface. Fig. 112.—Method of preparing a flap before shifting it to its new position, by raising itsbody^from the underlying tissues and keeping them separated with paraffined linen. Neither pedicle is severed at first, but after a week the extremity which is to be the freeend is separated by gradual notching on one or both sides. In this way the blood supplyof a long narrow flap may be practically assured before it is transplanted. drainage until proper vessel drainage is established (Fig. in). Thisprocedure I have found very satisfactory. When a long narrow flap isrequired and there is doubt about the blood supply, it is advisable toraise the flap from its bed but leave it attached at each end (a mxcthodemphasized by Croft, but also practised by Tagliacozzi in his originaloperation). After the flap has been raised it is advisable to close theskin beneath the flap, or else to keep it separated from its bed withrubber tissue; or the bed beneath
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