An island flap is created by using the adjacent healthy tissue to repair a defect. It is the workhorse flap of advanced skin cancer reconstruction. The island flap is usually triangular or a tear-drop shape. Its hallmark is avoidance of additional skin excision and even distribution of repair tension. The island flap uses fewer incisions and creates less scarring than local skin flaps.
The flap is incised and released from all the surrounding skin attachments and at least from half of the deep tissue attachments. The blood supply of the skin component comes from the deeper tissue below the skin island - usually from muscle or fascia (connective tissue). The deeper tissues carry the blood vessels along the length of the deep tissue pedicle.
There is minimal tension in the repaired area because it is evenly distributed around the flap. The island flap is a work horse of advanced reconstructive surgery. Because it is a challenging flap to design and execute, its use is limited to surgeons experienced in this technique. These flaps are also very vascular, requiring surgical suction to evacuate the bleeding in order for the surgeon to see. Surgical suction is only available in surgery centers and not in offices. Therefore, island flaps cannot easily be performed in office settings.
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