Introduction to tissue movements - Principles of flaps

The practice of surgical dermatology allows the dermatologist to take overall management of patients, particularly in the domain of skin cancer. It is the dermatologist who makes a diagnosis based on his expertise and his understanding, determines the tumour edges and the surgical margins to be applied, carries out the excision and repair procedures, and performs monitoring. Such comprehensive management requires knowledge of fundamental principles that allow for repair procedures suited to specific sites. Normally, simple repair involving direct suture can be performed using the intrinsic elasticity and plasticity of skin. However, depending on the site and the extent of substance loss, it may be necessary to perform a more complex repair by recruiting adjoining skin to create a flap. Skin flaps follow certain shared general rules. Their primary purpose is to fill in for surgically removed tissue that cannot be corrected by suturing by simply moving them from their current anatomical placement, creating a second and different shaped tissue loss at a point where simple wound closure may be effected thanks to looseness of the skin. In this article, we lay the groundwork for reflection on the practice of autoplasty, we set out the rules required to ensure optimal results, and we explain the various types of flaps using a classification based on tissue mobilization including advancement, rotation and transposition flaps.