The Classification, Design And Clinical Application Of Expanded Transposition Flaps

Background: How to apply the expanded tissues technique in a way of simplicity, availability, safety and efficiency still remains a challenge. Some colleagues exercised the transposition principles and the back cut flap concepts in expanded flaps and yielded remarkable successes on some special shaped expanders. However, a detailed classification and design principles of expanded transposition flaps and how to prevent the secondary flap congestion were still lacking.Objective: To review the development of the tissue expansion technique and to introduce the classification, design and application of the transposed expanded skin flap.Methods: 257 expanded transposition flaps had been individually designed and transposed to reconstruct skin defects during the past 15 years. A classification and a design summarization were discussed in the current study in accordance with some flap transfer principles.Results: 257 expanded transposition flaps were divided into two main types: the regular and the composite. The regular expanded transposition (RET) flap was a typical transposition flap. The composite type was a combination of the transposition pattern with the advancement and/or rotation patterns and constitute of four subtypes. To increase the survival rate for back cut flaps, flap delay procedure and the addition of a composite capsule tissue pedicle were the effective solutions.Conclusion : The application of individually designed expanded transposition flaps is a feasible and reliable solution in repairing the skin defects in a manner of maximal tissue utilization, safety and reliability.