Filatov Flap Surgery

What stages does the classic multi-stage Filatov flap surgery include?

Classic Filatov flap surgery includes three main surgical stages.

• Flap creation — formation of a skin tube at the selected donor site.
• Flap transfer — migration of the flap to the defect site, which can be carried out in stages (for example, via the forearm).
• Flap flattening — final replacement of the defect and formation of the lost organ.

Through which vessels is the autonomous blood supply of the Filatov flap maintained?

The blood supply to the Filatov flap is maintained via the vessels of the nutrient pedicles and the anastomoses forming between them.

• Days 1–5 — nutrition occurs exclusively through the vessels of the nutrient pedicle.
• By day 7 — vascular anastomoses form between the flap pedicles.
• By days 14–18 — complete restoration of vascular connections inside the flap is completed.

What specific complications are possible during the formation stage of the Filatov flap?

Filatov flap surgery can be complicated by a number of specific local complications.

• Hematomas — occur due to meticulous hemostasis failure in adipose tissue vessels or wound closure.
• Dermatitis — a consequence of friction between the native skin and the flap.
• Maceration under the flap pedicles — a result of impaired ventilation in tightly adjacent skin areas.
• Suture dehiscence on the flap — occurs due to necrosis, premature removal, or suture cutting through excess adipose tissue.
• Flap necrosis — develops as a result of insufficient blood supply and thrombosis.
• Detachment of the flap pedicle — associated with improper limb immobilization.

What is the principle of Limberg local skin plasty?

The principle of Limberg local skin plasty is the use of transposition (Z-plasty) triangular flaps to eliminate scar contractures and deformities.

• Classic technique — excision of the scar with the formation of two symmetrical transposition triangular flaps, which are mobilized and displaced over one another (transposition).
• Complex combinations — formation of three, four, or more flaps with symmetrical or asymmetrical angles (e.g., 60° and 36.5°).

This allows for an even distribution of tension, elongation of tissues, and spatial redistribution in multiple vectors.

How is the surgical training of the Filatov flap carried out before its migration?

Surgical training of the Filatov flap was historically performed to gradually enhance blood circulation within the flap during its maturation period.

• Technique — application of a fine tourniquet or clamp to the flap pedicle that is subsequently scheduled for division.
• Regimen — on the first day, compression is applied for 3–5 minutes, then the time is increased daily by 5–10 minutes.
• Readiness criterion — clamping the pedicle for 1 hour should not cause cooling, edema, or cyanosis of the flap.

An experimental study by N. I. Neupokoev showed that in untrained flaps by the 21st day, the level of tissue respiration reaches that of healthy skin, whereas in trained ones it lags behind the norm; trauma from tourniquets leads to deformation and cicatricial changes in the feeding vessels. Conclusion: training of the flap pedicles should be abandoned.