Using Delay Principle to Create Two Viable Flaps Within one Distant Pedicled Flap: How We Did it—A Case Report

From the time reconstruction is being performed, delay is a part of standard surgical staged procedure, wherein the procedure results in inducing ischemia to the tissues and hence ﬂ ap viability. 1 We present here a case, wherein we did a delay from the distal margin of an elevated ﬂ ap, which bisected a single ﬂ ap into two ﬂ aps to provide cover to two different regional defects with one ﬂ ap acting as a distant pedicled ﬂ ap and the other as a local transposition ﬂ ap. A 24-year-old man presented with high-tension electrical burns with multiple exposed bones at multiple locations. The patient had 4-degree burn with an exposed left iliac crest bone and an exposed ulnar bone ( ► Fig. 1A, B ). The patient was planned for a single pedicled thoraco-umbilical ﬂ ap (TU ﬂ ap), which could cover both the ulna and iliac crest bones, the intention was to resurface two exposed bones with a single pedicled ﬂ ap of two different anatomi-cal regions. After 3 weeks, the ﬂ ap was delayed from the distal margin and bisected from the middle of ﬂ ap to produce two different individual ﬂ aps to resurface both the exposed bones without any pull in the opposite direc-tion; hence ﬂ aps were lying snugly on their respective position ( ► Fig. 2 ). The delay to bisect the ﬂ ap was done in two stages of 5cm, 7cm length, respectively, with an interval of 1 week. After bisecting the whole ﬂ ap, the inset was given to cover both the defects without any tension ( ► Fig. 3A, B ). The mechanism of