Local or subdermal plexus flaps. The flap is then mobilized with its base situated at the inferior aspect of the forehead and often around the orbital rim (fig.1c). H-plasties have a wider base:length ratio, improving blood supply when compared to a single pedicle advancement flap. Interpolation flaps can generally be performed with one surgical assistant, primarily to help manage bleeding and cut suture. The portion of the template representing the lateral wound edge furthest from the flap is placed most inferiorly (or distally) on the cheek, touching the mark previously placed on the cheek. If there is any question of the viability of the flap at the planned division, the pedicle can be pinched to observe the distal flap tip. The unsutured portion of the pedicle is wrapped with petrolatum-saturated gauze ribbon, followed by application of non-adherent surgical dressing and then fluffed gauze over the entire surgical site. [5] Cheek interpolation flaps are useful on the distal third of the nose, especially laterally, in situations in which adjacent tissue transfer or full-thickness grafts are not practical.
Gilles and Fillatov described the tubed pedicle flap in the early 1900s.

3c). Szentimrey D. Principles of reconstructive surgery for the tumor patient. Minor revision procedures may be indicated during the coming weeks, and it is best to discuss this with the patient prior to starting this flap. [Level 5].

The PFF uses tissue from the forehead to repair larger, deeper defects on the distal nose (fig. 2019 Sep, Paramedian forehead flap: advances, procedural nuances, and variations in technique., Jellinek NJ,Nguyen TH,Albertini JG,, Dermatologic surgery : official publication for American Society for Dermatologic Surgery [et al. Also, given the prolonged surgical and recovery times and the high metabolic demands of muscle and myocutaneous flaps, nutrition should be optimized when possible. Muscle and myocutaneous flaps, utilized in pedicled or free tissue transfer, are work-horse flaps with numerous advantages in oncologic and traumatic reconstruction.  Waltzing: It is a technique wherein flap is moved from donor area and attached adjacent to recipient defect area. The forehead donor site is closed primarily and if the wider portion of that defect will not close completely, it is preferable to allow it to heal secondarily rather than to apply a skin graft (fig.1d). In addition, avoiding the use of previously radiated skin or a previous surgical site is generally best, unless no better repair options are available. Plastic and reconstructive surgery. Local or pedicled muscle flaps do not require any specialized equipment beyond a typical plastic surgery set. This takes tension off the interpolation flap and also helps apply pressure to minimize risk of bleeding. If no significant bleeding is noted, a less bulky dressing can be applied at that time. Assuming a well-vascularized wound bed, vascular ingrowth is seen by four to five days though sufficient vascular ingrowth to supply a flap independent of its blood supply requires weeks. Waltzing a facial artery musculomucosal flap to salvage a recurrent palatal fistula. As antibiotics had not yet been invented when this procedure was developed, wrapping the flap in a tube was important because infection was reduced.

1987 Mar; Hartrampf CR,Scheflan M,Black PW, Breast reconstruction with a transverse abdominal island flap. J Craniofac Surg. Get the latest public health information from CDC: https://www.coronavirus.gov. 2004 May; Noszczyk BH, The origins of the concept of muscle flaps. In instances where just a portion of the muscle is needed to fashion a flap, e.g., a vertical rectus abdominis myocutaneous flap or partial superior latissimus muscle, care is undertaken to preserve remaining muscle blood supply to minimize donor site morbidity.
The total length should not exceed twice the width of the flap base.

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