Workup
Laboratory Studies
Laboratory studies are not required in the vast majority of wound closure settings, but in cases of complex wounds or chronic/nonhealing wounds, they may aid the surgeon in tailoring treatment. Nutrition laboratory studies, including albumin, prealbumin, and transferrin levels, can indicate if the patient is appropriately nourished and able to heal the wound. Zinc or iron deficiencies, along with other mineral deficiencies, can prolong or inhibit the wound healing process altogether. Similarly, deficiencies in vitamin C, D, and other key vitamins can prevent a patient's wounds from properly healing. In select patients, a preoperative nutritional workup may be warranted.
Media Gallery
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Preoperative planning for a banner flap to repair a facial defect (same patient as in Image 2).
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Postoperative photo showing the completed banner flap repair (same patient as in Image 1).
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A nasal defect after excision of squamous cell carcinoma and prior to repair with an interpolated flap (same patient as in Images 4-6).
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The preoperative plan for the interpolated flap is designed to leave the donor scar in the natural wrinkle line of the nasolabial fold (same patient as in Images 3 and 5-6). The interpolated flap is most similar to a banner flap, and, in this case, it is folded over to reconstruct the nasal ala.
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Intraoperative appearance of the interpolated flap, folded upon itself to provide greater thickness and coverage of skin and mucosal surfaces (same patient as in Images 3-4 and 6).
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Final appearance of the interpolated flap repair, illustrating the advantage of placing the donor scar along a natural wrinkle line (same patient as in Images 3-5).
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A large lesion of the right cheek amenable to repair with a rotation flap (same patient as in Images 8-9).
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An intraoperative illustration of the rotation (cervicofacial) flap transposed into the defect site (same patient as in Images 7 and 9).
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Postoperative appearance of the completed rotation flap repair of the right cheek defect (same patient as in Images 7-8).
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A leiomyosarcoma of the scalp to be excised and closed via opposing rotation flaps (same patient as in Images 11-13).
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A scalp defect following excision of a leiomyosarcoma. Preoperative marking for repair with opposed rotation flaps is seen in blue. The anterior portion of the scar is oriented parallel to the patient's original hairline (as indicated by the dashed line) (same patient as in Images 10 and 12-13).
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Postoperative appearance of the opposed rotation flaps scalp repair (same patient as in Images 10-11 and 13).
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Final appearance of the rotation flap scalp repair (same patient as in Images 10-12).
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A lesion due to amyloidosis amenable to a V-Y closure (same patient as in Images 15-16).
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Postoperative appearance of the V-Y advancement flap (same patient as in Images 14 and 16).
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Final appearance of the V-Y advancement flap closure (same patient as in Images 14-15).
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Patient with an ischemic wound of left lower extremity status post ileopopliteal bypass revascularization (same patient as in Images 18-20).
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Left lower extremity wound immediately following eschar debridement (same patient as in Images 17, 19-20).
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Defect prepared for reconstruction following serial debridement with interval dressing changes and vacuum-assisted closure therapy (same patient as in Images 17-18, 20).
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Left lower extremity wound fully healed at 2 years following meshed split-thickness skin grafting (same patient as in Images 17-19).
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Lateral plantar foot ulceration, just proximal and in line with the fourth webspace, prior to excision and reconstruction (same patient as in Images 22-23).
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Intraoperative markings for the proposed pedicled flap, based on the medial plantar digital artery of the first plantar metatarsal artery (FPMA). Note the vertical marking signifying the pedicle (FPMA) course and length, as well as the proposed segment of tissue in the first webspace to be used for reconstruction (same patient as in Images 21, 23).
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Postoperative clinic visit showing transposition/rotation and inset of medial plantar digital artery island flap into defect. The extent of proximal pedicle dissection can be seen by the longitudinal scar in line with the first webspace (same patient as in Images 21-22).
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Significant posterior ankle defect with exposed Achilles tendon, precluding skin grafting (same patient as in Images 25-26).
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Templated design of a 4 x 12 cm free radial forearm flap based on the radial artery (same patient as in Images 24, 26).
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Recipient site following free radial forearm flap anastomosis to the posterior tibial vessels, flap inset, and closure demonstrating excellent coverage, contour, and plantarflexion function (same patient as in Images 24-25).
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Patient with significant scalp alopecia extending from ear to ear (same patient as in Images 28-30).
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Design and inset of a posteriorly based tissue expander for staged reconstruction (same patient as in Images 27, 29-30).
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Patient following serial expansion, removal of expander, and scalp flap advancement of hair-bearing tissues (same patient as in Images 27-28, 30).
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Postoperative result showing near-anatomic reconstruction of hair-bearing scalp tissues (same patient as in Images 27-29).
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