Prevention of flap necrosis

Flap necrosis can be prevented if the surgeon attends to four basic principles.

1. First, the apex of a flap should never be wider than the base, unless a major artery is present in the base.  (Fig.)

2. In general the length of a flap should be no more than twice the width of the base.

3. An axial blood supply should be included in the base of the flap.

4. The base of the flaps should not be excessively twisted or stretched, because either of these maneuvers may compromise the supplying vessels.