Flaps and Tissue Transfer Options in Wound Closure: A Plastic Surgery Perspective Part II

Part I reviewed wound healing biology and a pragmatic reconstructive ladder for interventional radiology (IR) access and postprocedural wounds. Part II focuses on flap and tissue transfer options: why and when they are needed, how they work physiologically, and how to think about anatomy and risk in a way that is clinically useful to non-surgeons. The emphasis is on common wound scenarios relevant to IR (groin and thigh access, upper limb access, device- or graft-adjacent breakdown, radiated tissue, infected hematomas, and exposed critical structures). We describe local, regional pedicled, and free tissue transfer strategies; composite and chimeric concepts; and tissue expansion as a staged solution. Practical peri‑procedural tips are included to help IR teams identify escalation triggers early and communicate effectively with reconstructive services. Early recognition of perfusion, contamination, and mechanical failure patterns allows timely referral and reduces reconstructive complexity. The goal is to provide IR clinicians with a clear decision-making framework that improves multidisciplinary communication and patient outcomes.