skin flap types plastic surgery classification

rotation advancement transposition flap reconstructive surgery diagram

free flap microsurgery anastomosis perforator flap

Z-plasty myocutaneous flap wound reconstruction lower limb

ls -la /home/daytona/workspace/ && mkdir -p /home/daytona/workspace/flaps-plasti…

~/flaps-plastics-pptx/build_flaps_presentation.js

const pptxgen = require('pptxgenjs');

const pptx = new pptxgen();
pptx.layout = 'LAYOUT_WIDE';
pptx.author = 'Orris';
pptx.subject = 'Plastic surgery flap reconstruction';
pptx.title = 'Flaps in Plastic Surgery for Surgery Residents';
pptx.company = 'Medical Education';
pptx.lang = 'en-US';
pptx.theme = {
  headFontFace: 'Calibri',
  bodyFontFace: 'Calibri',
  lang: 'en-US'
};

const COLORS = {
  bg: '0F172A',
  bg2: '111827',
  primary: '0EA5E9',
  accent: '22C55E',
  warn: 'F59E0B',
  danger: 'EF4444',
  text: 'E5E7EB',
  muted: '94A3B8',
  white: 'FFFFFF'
};

function addTitle(slide, title, subtitle='') {
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  slide.addText(title, { x: 0.6, y: 0.45, w: 12.1, h: 0.6, color: COLORS.white, fontSize: 30, bold: true, margin: 0 });
  if (subtitle) {
    slide.addText(subtitle, { x: 0.6, y: 1.05, w: 12.1, h: 0.45, color: COLORS.muted, fontSize: 15, margin: 0 });
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}

function addFooter(slide, page) {
  slide.addShape(pptx.ShapeType.line, { x: 0.6, y: 7.05, w: 12.1, h: 0, line: { color: '334155', pt: 1 } });
  slide.addText('Surgery Resident Teaching Deck', { x: 0.6, y: 7.1, w: 6.0, h: 0.2, color: '94A3B8', fontSize: 9 });
  slide.addText(String(page), { x: 12.4, y: 7.1, w: 0.3, h: 0.2, color: '94A3B8', fontSize: 9, align: 'right' });
}

function addBullets(slide, items, x=0.8, y=1.5, w=12, h=5.2, fs=20) {
  const runs = [];
  items.forEach((t, i) => {
    runs.push({ text: t, options: { bullet: { indent: 20 }, breakLine: i !== items.length - 1, color: COLORS.text } });
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  slide.addText(runs, { x, y, w, h, fontSize: fs, margin: 2, paraSpaceAfterPt: 10, valign: 'top' });
}

let s;
let p = 1;

s = pptx.addSlide();
addTitle(s, 'Flaps in Plastic Surgery', 'Comprehensive resident-level review: principles, planning, execution, and complications');
s.addText('Target audience: General surgery and plastic surgery residents', { x: 0.8, y: 1.8, w: 8, h: 0.4, color: COLORS.primary, fontSize: 18, bold: true });
addBullets(s, [
  'Decision-making from reconstructive ladder to elevator',
  'Flap classification: blood supply, tissue composition, movement, donor relation, transfer method',
  'Design geometry and biomechanics of advancement, rotation, transposition, interpolation and free flaps',
  'Intraoperative technique, postoperative monitoring and salvage pathways',
  'Complications, prevention and exam-focused high-yield pearls'
], 0.8, 2.3, 11.7, 3.9, 18);
addFooter(s, p++);

s = pptx.addSlide();
addTitle(s, 'Learning Objectives');
addBullets(s, [
  'Define a flap and contrast flap versus graft using vascular biology and healing implications',
  'Classify commonly used flaps and select the appropriate option based on defect requirements',
  'Apply flap design rules: perfusion limits, pedicle handling, arc of rotation, tension redistribution',
  'Outline core steps of flap elevation, inset, donor-site closure and postoperative surveillance',
  'Recognize vascular insufficiency and venous congestion early and initiate salvage actions',
  'Discuss practical examples for face, trunk, extremity and complex oncologic/trauma reconstruction'
], 0.9, 1.55, 12.0, 5.6, 20);
addFooter(s, p++);

s = pptx.addSlide();
addTitle(s, 'Why Flaps Matter in Surgical Reconstruction');
addBullets(s, [
  'Indications: exposed bone without periosteum, tendon without paratenon, cartilage, hardware, irradiated bed, dead space',
  'Flaps bring vascularized tissue, improving resistance to infection and supporting antibiotic delivery and healing',
  'Flaps allow functional restoration with durable soft tissue, contour restoration, and better aesthetic integration',
  'Unlike grafts, flaps tolerate less ideal recipient beds because they carry their own blood supply'
], 0.8, 1.55, 7.5, 4.8, 17);
s.addImage({ path: 'https://cdn.orris.care/cdss_images/f002d6b153ed7b5a4f81637f6db015bfea5632f755bc4746fcb503b4eca1a16b.png', x: 8.4, y: 1.8, w: 4.4, h: 3.8 });
s.addText('Radial forearm flap example', { x: 8.4, y: 5.65, w: 4.5, h: 0.25, color: COLORS.muted, fontSize: 10, align: 'center' });
addFooter(s, p++);

s = pptx.addSlide();
addTitle(s, 'Flap Definition and Core Concepts');
addBullets(s, [
  'A flap is full-thickness skin/subcutaneous tissue ± deeper tissues transferred with an intact vascular pedicle',
  'Primary movement: tissue moved into defect; secondary movement: donor tissue shifts to permit closure',
  'Successful flap surgery balances perfusion, tension vectors, and three-dimensional tissue match',
  'Principle: design should place closure tension away from critical distal flap perfusion zones'
], 0.9, 1.55, 12, 4.7, 19);
s.addShape(pptx.ShapeType.roundRect, { x: 0.9, y: 5.7, w: 12, h: 1.0, fill: { color: '1E293B' }, line: { color: '334155', pt: 1 } });
s.addText('High-yield: pedicle width alone does not guarantee survival; vascular territory and perfusion pressure are the limiting determinants of flap length.', { x: 1.1, y: 5.96, w: 11.6, h: 0.5, color: 'FDE68A', fontSize: 15, italic: true });
addFooter(s, p++);

s = pptx.addSlide();
addTitle(s, 'Classification I: Blood Supply');
addBullets(s, [
  'Random-pattern flaps: based on subdermal plexus microcirculation; commonly used in local facial reconstruction',
  'Axial-pattern flaps: incorporate a named vessel in the pedicle; permit longer and narrower designs',
  'General perfusion hierarchy: axial > musculocutaneous > fasciocutaneous > random',
  'Guideline ratios: face random flaps often up to 3:1; trunk/extremity generally more conservative (about 2:1)'
], 0.8, 1.5, 7.2, 4.6, 16);
s.addImage({ path: 'https://cdn.orris.care/cdss_images/BAILY_1760542286289_323bb701-2a2e-4f2d-a96c-7b49daba858d.png', x: 8.1, y: 1.65, w: 4.8, h: 3.8 });
s.addText('Rotation flap planning diagram', { x: 8.2, y: 5.52, w: 4.7, h: 0.25, color: COLORS.muted, fontSize: 10, align: 'center' });
addFooter(s, p++);

s = pptx.addSlide();
addTitle(s, 'Classification II: Tissue Composition and Transfer Type');
addBullets(s, [
  'Cutaneous, fasciocutaneous, musculocutaneous, osteocutaneous, chimeric, perforator, innervated flaps',
  'Local/regional pedicled flaps versus distant free tissue transfer (microvascular anastomosis)',
  'Single-component flaps are simpler; composite/chimeric flaps reconstruct complex three-dimensional defects',
  'Choose tissue components by defect requirements: cover, bulk, lining, structural support, function'
], 0.8, 1.45, 7.2, 4.9, 16);
s.addImage({ path: 'https://cdn.orris.care/cdss_images/pmc_clinical_VQA_526d2d6a02c90d0ea851369d2cacf6b6051e0cb6eb341612d8086cd7d395c9a1.jpg', x: 8.2, y: 1.6, w: 4.6, h: 3.95 });
s.addText('Chimeric flap specimen', { x: 8.25, y: 5.58, w: 4.5, h: 0.25, color: COLORS.muted, fontSize: 10, align: 'center' });
addFooter(s, p++);

s = pptx.addSlide();
addTitle(s, 'Movement-based Flap Types');
addBullets(s, [
  'Advancement: linear movement into defect; useful in rectangular or straight-edge defects',
  'Rotation: semicircular curvilinear flap rotates about a pivot point to close triangular/oval defects',
  'Transposition: flap lifted and moved over intervening intact skin to adjacent defect (e.g., rhombic)',
  'Interpolation: flap reaches nonadjacent defect with temporary external pedicle, divided later',
  'Most flaps are hybrid movements; design must anticipate standing cone deformities and tension distribution'
], 0.8, 1.55, 12.0, 5.3, 18);
addFooter(s, p++);

s = pptx.addSlide();
addTitle(s, 'Reconstructive Ladder, Triangle, and Elevator');
addBullets(s, [
  'Ladder progression: secondary intention -> primary closure -> graft -> local flap -> regional flap -> free flap',
  'Modern strategy (elevator): select best option first based on defect biology, not merely lowest rung',
  'Consider patient factors: comorbidities, smoking, vascular disease, radiation, anticoagulation, nutrition',
  'Consider defect factors: size, depth, contamination, exposed critical structures, expected adjuvant therapy'
], 0.8, 1.55, 12.0, 5.1, 17);
addFooter(s, p++);

s = pptx.addSlide();
addTitle(s, 'Preoperative Planning Checklist');
addBullets(s, [
  'Define defect: dimensions, depth, tissue components missing (skin/soft tissue/mucosa/bone/tendon)',
  'Map vascular anatomy: handheld Doppler ± CTA/MRA for perforator/free flap planning in selected cases',
  'Assess recipient vessels and zone of injury; plan for vessel-depleted neck or traumatized limb scenarios',
  'Plan flap geometry on skin with relaxed skin tension lines and functional subunits in mind',
  'Build contingency plans: backup flap, vein graft strategy, postoperative anticoagulation/monitoring protocol'
], 0.8, 1.5, 12.0, 5.4, 17);
addFooter(s, p++);

s = pptx.addSlide();
addTitle(s, 'Flap Design Biomechanics: Practical Rules');
addBullets(s, [
  'Broader base improves inflow/outflow reliability for random flaps, but excessive base alone cannot overcome poor territory',
  'Place pivot point and arc to avoid pedicle kinking, torsion, or compression',
  'Wide undermining in appropriate plane reduces closure tension and preserves subdermal plexus',
  'Anticipate dog-ears and standing cutaneous deformities; design Burow triangles proactively',
  'Use delayed inset/staged transfer when perfusion uncertainty is high'
], 0.8, 1.5, 7.3, 5.3, 16);
s.addImage({ path: 'https://cdn.orris.care/cdss_images/pmc_clinical_VQA_8b75c13947cbe32198b15821171266e9aedc0ba646850c513add96867382f91d.jpg', x: 8.2, y: 1.65, w: 4.6, h: 3.95 });
s.addText('Pedicled flap dissection', { x: 8.25, y: 5.62, w: 4.5, h: 0.25, color: COLORS.muted, fontSize: 10, align: 'center' });
addFooter(s, p++);

s = pptx.addSlide();
addTitle(s, 'Classic Local Flaps: Pearls and Pitfalls');
addBullets(s, [
  'Advancement flap: straightforward design; pitfall is distal tip ischemia from high closure tension',
  'Rotation flap: broad arc decreases tension; pitfall is inadequate arc leading to standing cone and distortion',
  'Rhombic/transposition flap: robust geometric planning; pitfall is poor orientation relative to relaxed tension lines',
  'Bilobed flap: excellent for small nasal defects; pitfall is trapdoor deformity if angles or thickness are inappropriate',
  'Interpolation flap (e.g., paramedian forehead): reliable for complex nasal defects; requires staged pedicle division'
], 0.8, 1.5, 12.0, 5.4, 16);
addFooter(s, p++);

s = pptx.addSlide();
addTitle(s, 'Regional and Distant Pedicled Flaps');
addBullets(s, [
  'Regional options provide larger tissue volume and improved vascular reliability over random local flaps',
  'Examples: pectoralis major flap, latissimus dorsi flap, gastrocnemius flap, groin flap',
  'Useful when free flap resources are limited or recipient vessels are poor',
  'Drawbacks: limited reach/arc, bulk mismatch, donor-site morbidity, potential functional deficit'
], 0.8, 1.6, 7.1, 4.9, 16);
s.addImage({ path: 'https://cdn.orris.care/cdss_images/pmc_clinical_VQA_ad72b968a60280cbd03dfdedbe1a937efe78defe58517c749162edaada67666c.jpg', x: 8.2, y: 1.7, w: 4.6, h: 3.9 });
s.addText('Gastrocnemius rotational flap sequence', { x: 8.1, y: 5.62, w: 4.8, h: 0.25, color: COLORS.muted, fontSize: 10, align: 'center' });
addFooter(s, p++);

s = pptx.addSlide();
addTitle(s, 'Free Flaps and Microsurgery Fundamentals');
addBullets(s, [
  'Free flap = tissue completely detached and revascularized at recipient site by microvascular anastomosis',
  'Common workhorse flaps: ALT, radial forearm, fibula osteocutaneous, scapular/parascapular, DIEP',
  'Critical steps: atraumatic harvest, pedicle preparation, recipient vessel prep, tension-free inset, flow check',
  'Technical errors causing failure: twist, kinking, size mismatch, intimal injury, compression hematoma'
], 0.8, 1.5, 7.1, 4.9, 16);
s.addImage({ path: 'https://cdn.orris.care/cdss_images/pmc_clinical_VQA_9469a5c693cb9aca2716c23d1aa20c28200b9602a7b9d30781be3fefb0e03790.jpg', x: 8.2, y: 1.65, w: 4.6, h: 3.95 });
s.addText('ALT free flap: harvest to inset', { x: 8.2, y: 5.62, w: 4.7, h: 0.25, color: COLORS.muted, fontSize: 10, align: 'center' });
addFooter(s, p++);

s = pptx.addSlide();
addTitle(s, 'Perforator Flaps: Concept and Advantages');
addBullets(s, [
  'Perforator flaps are based on isolated perforating vessels while sparing source muscle',
  'Advantages: reduced donor functional morbidity, longer pedicle options, tailored tissue thickness',
  'Challenges: variable anatomy, meticulous intramuscular perforator dissection, learning curve',
  'Examples: DIEP, ALT perforator-dominant harvest, thoracodorsal artery perforator (TDAP) flap'
], 0.8, 1.55, 7.1, 4.8, 16);
s.addImage({ path: 'https://cdn.orris.care/cdss_images/pmc_clinical_VQA_2a1d4823508b52ac34ca69cf1dc7880c07772d05e23777bc79170108b7cd2f86.jpg', x: 8.2, y: 1.75, w: 4.6, h: 3.8 });
s.addText('ALT septocutaneous perforator flap', { x: 8.2, y: 5.6, w: 4.8, h: 0.25, color: COLORS.muted, fontSize: 10, align: 'center' });
addFooter(s, p++);

s = pptx.addSlide();
addTitle(s, 'Postoperative Monitoring and Early Salvage');
addBullets(s, [
  'Most thrombotic failures occur in first 24-72 hours: frequent monitoring is non-negotiable',
  'Clinical checks: color, capillary refill, turgor, temperature, pin-prick bleeding characteristics',
  'Adjuncts: handheld Doppler, implantable Doppler, NIRS, fluorescence perfusion imaging',
  'Venous congestion signs: purple/dusky flap, brisk dark bleeding, rapid edema -> urgent return to OR',
  'Arterial insufficiency signs: pale cool flap, delayed refill, absent Doppler signal -> immediate exploration'
], 0.8, 1.5, 7.1, 5.3, 15);
s.addImage({ path: 'https://cdn.orris.care/cdss_images/pmc_clinical_VQA_f38dc3a9ee618b492c60b6e8e4654a2f9c8cc529dbe7aefd34649e0db60e96d3.jpg', x: 8.2, y: 1.7, w: 4.6, h: 3.9 });
s.addText('Fluorescence-guided perfusion assessment', { x: 8.1, y: 5.62, w: 4.8, h: 0.25, color: COLORS.muted, fontSize: 10, align: 'center' });
addFooter(s, p++);

s = pptx.addSlide();
addTitle(s, 'Complications and Management');
addBullets(s, [
  'Early: arterial/venous thrombosis, hematoma, pedicle compression, partial or total flap necrosis, infection',
  'Late: contour deformity, trapdoor effect, bulk mismatch, scar contracture, donor-site morbidity',
  'Preventive strategy: strict hemostasis, atraumatic handling, no pedicle tension/twist, meticulous inset',
  'When in doubt, re-explore early: delay converts salvageable vascular compromise into irreversible loss'
], 0.8, 1.6, 12.0, 4.8, 17);
s.addShape(pptx.ShapeType.roundRect, { x: 0.8, y: 5.75, w: 12.0, h: 1.0, fill: { color: '3F1D1D' }, line: { color: '7F1D1D', pt: 1 } });
s.addText('Resident pearl: A threatened flap is an OR diagnosis, not a ward diagnosis. Escalate immediately.', { x: 1.05, y: 6.02, w: 11.5, h: 0.4, color: 'FECACA', fontSize: 16, bold: true });
addFooter(s, p++);

s = pptx.addSlide();
addTitle(s, 'Case-based Algorithm: Lower Limb Trauma Defect');
addBullets(s, [
  'Step 1: Radical debridement and skeletal stability first (orthoplastic principle)',
  'Step 2: Determine zone of injury and vessel quality; avoid anastomosis in traumatized segment',
  'Step 3: Small superficial defect -> local/regional options; deep exposed hardware -> robust flap coverage',
  'Step 4: Choose flap by reach and tissue need (muscle for dead space/infection, fasciocutaneous for contour)',
  'Step 5: Time reconstruction early when feasible, coordinated with infection control and fixation plan'
], 0.8, 1.55, 7.2, 5.2, 15);
s.addImage({ path: 'https://cdn.orris.care/cdss_images/pmc_clinical_VQA_2873a5cc2b4a8444c05ce82db5bbcdfdf162cee697e452bb1e92e7fec18858cc.jpg', x: 8.2, y: 1.75, w: 4.6, h: 3.85 });
s.addText('Muscle flap + graft in limb salvage', { x: 8.2, y: 5.62, w: 4.7, h: 0.25, color: COLORS.muted, fontSize: 10, align: 'center' });
addFooter(s, p++);

s = pptx.addSlide();
addTitle(s, 'Exam and Viva High-Yield Points');
addBullets(s, [
  'Flap survives by carried blood supply; graft survives by plasmatic imbibition then inosculation',
  'Random flap reliability is territory/perfusion dependent; pedicle width is only one variable',
  'Always state classification in multiple axes: blood supply + movement + tissue type + transfer method',
  'Failure to identify venous congestion early is a common avoidable cause of free flap loss',
  'Functional and aesthetic subunit replacement principles improve long-term outcomes'
], 0.9, 1.55, 12.0, 5.4, 18);
addFooter(s, p++);

s = pptx.addSlide();
addTitle(s, 'Summary');
addBullets(s, [
  'Flap reconstruction is a physiology-driven and geometry-driven discipline',
  'Good outcomes come from correct flap selection, precise design, atraumatic technique, and vigilant monitoring',
  'Master core local and regional flaps first; build toward microsurgical decision-making and execution',
  'Early recognition and decisive salvage actions determine limb, function, and survival of reconstruction'
], 0.9, 1.9, 11.8, 3.9, 21);
addFooter(s, p++);

s = pptx.addSlide();
addTitle(s, 'References');
addBullets(s, [
  'Fitzpatrick\'s Dermatology, FLAPS section. Key principles for random vs axial perfusion and movement-based classification.',
  'Miller\'s Review of Orthopaedics, Upper extremity wounds and flap indications/classification.',
  'Mulholland & Greenfield\'s Surgery, Axial pattern flap principles.',
  'Representative educational clinical images sourced via medical image library search.'
], 0.8, 1.65, 12.0, 4.8, 15);
s.addText('Textbook-derived concepts were used for educational synthesis for resident teaching.', { x: 0.8, y: 6.2, w: 12, h: 0.35, color: COLORS.muted, fontSize: 11, italic: true });
addFooter(s, p++);

pptx.writeFile({ fileName: '/home/daytona/workspace/flaps-plastics-pptx/Flaps_in_Plastic_Surgery_Resident.pptx' });

node /home/daytona/workspace/flaps-plastics-pptx/build_flaps_presentation.js

ls -la /home/daytona/workspace/flaps-plastics-pptx/ && python /home/daytona/skil…