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In situ Transverse Rectus Abdominis Myocutaneous Flap: A Rat Model of Myocutaneous Ischemia Reperfusion Injury
Published on: June 8, 2013
The remote flap technique: recruiting regional laxity for reconstruction of high-tension cutaneous defects a
1Director of Plastic Surgery, Sunshine Coast University Hospital, Sunshine Coast, Queensland, Australia.
Background:
Local flaps recruit laxity into a defect through incisions that extend from the defect into the immediately surrounding tissue; these incisions can disturb peri-defect perfusion and place scars within the aesthetic unit of the defect. The remote flap technique is a reconstructive strategy rather than a single flap entity. A zone of regional or distant laxity is identified away from the defect and recruited to achieve closure without an incision connecting the flap to the defect - the feature that distinguishes it from a conventional local flap - keeping the reconstructive work, and the resulting scar, away from the defect where this is advantageous. The flap raised at the remote site may itself be constructed as a local, pedicled, or free flap.
Methods:
A retrospective audit of 100 consecutive patients (112 remote flaps) treated at Kawana Private Hospital, Sunshine Coast, Australia, between 25 May 2022 and 1 January 2025 was performed, and flap-related complications were recorded. The operative principles, flap design, and a decision framework for the technique are described, with selected additional cases presented to illustrate specific considerations.
Results:
All 100 patients achieved successful reconstruction with 112 remote flaps. Lesions were squamous cell carcinoma (46.4%), basal cell carcinoma (26.8%), invasive melanoma (8.9%), melanoma in situ (8.0%), intraepidermal carcinoma (8.9%), and other (0.9%). Flap-related complications were infrequent: infection 3.6% (4/112) and dehiscence 0.9% (1/112), total 4.5% (95% CI 1.5-10.1%). Excision-related incomplete margins, independent of the flap, occurred in 1.8% (2/112).
Conclusion:
In this single-surgeon series the remote flap technique was a safe and reproducible option for high-tension cutaneous defects, with a flap-related complication profile consistent with published local-flap reconstruction. Potential advantages in local tissue preservation and scar placement are described but were not formally measured and require prospective comparative study.