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- If it is not possible to achieve a defective closure by primary suturing or extensoplasty, more advanced plastic surgery methods must be used. Their mastery is essential, especially in oncological indications, since histologically confirmed in toto excision of malignant skin tumors often results in larger defects that can only be treated by means of plastic reconstructive surgical procedures. Basically, a distinction must be made between the methods of local and regional plastic surgery and those of distant plastic surgery.
- The techniques belonging to the near and regional plastics usually offer optimal solutions for the majority of defect coverages required in the context of operative dermatology, especially in the head and neck region. Taking into account the different anatomical and aesthetic regions, the quality and structure of the donor sites largely correspond to those of the receptor site. Thus, an important prerequisite for favorable cosmetic results is fulfilled. Most sutoplasties can be characterized as displacement, rotation or transposition due to their essential displacement technique.
- The skin flaps consist of cutis and subcutis and are displaced in the defect, and the resulting defect can be primarily closed or transplanted. The advantage over grafts is primarily where the skin over fascia is subject to severe displacement (shoulder, back, abdominal wall, proximal extremities and joints), further where cartilage and bone are exposed. Arteriovenous supply is usually left to chance in skin flaps. Therefore, depending on the body region, the ratio of flap length to flap base should be a maximum of 1:1 (for lower leg), 2:1 (for trunk) or 5:1 (for face). The most common skin flap plastics are stretching plastics, M-plastics, displacement flaps with laterally offset compensation triangles according to von Burow, rotation flaps, Z-plastics, transposition flaps (swivel plastics) and subcutaneously pedicled sliding flaps (VY flaps).