Flap procedures

The concept model for flap procedures is based on three attributes in a role group as outlined below:

363701004 |Direct substance (attribute)|

363701004 |Direct substance (attribute)| must have a value from the 256683004 |Flap (substance)| subhierarchy, and indicate the direct flap substance composition, and its blood supply.
363701004 |Direct substance (attribute)| must be used for flap procedures (and not 424361007 |Using substance (attribute)|).
Flap substances exist for free flaps and pedicle flaps (<<261238005 |Free flap (substance)| and << 261235008 |Pedicle flap (substance)|) and reflect the fact that whether a flap is free or pedicle is also a function of its blood supply (i.e. completely unattached from its original blood supply, or still attached via a vascular pedicle).
Also see Flap (substance) editorial guidance.

For flap reconstruction procedure, 260686004 |Method (attribute)| must have a value from the 360032005 |Flap reconstruction - action (qualifier value)| subhierarchy and indicate the flap procedure technique, for example, advancement or rotation of flap.
For free flap procedures, the method is 1193839003 |Distant flap reconstruction - action (qualifier value)|
The proximity of the flap donor site to the flap recipient site (local flap/distant flap) must be modeled as part of the methodology of the procedure (and is no longer a characteristic of the flap substance).

For example,

1193839003 |Distant flap reconstruction - action (qualifier value)| relates to the remote distance between the donor site and the recipient site.

When the donor site is indicated in the FSN, for a flap reconstruction procedure for example, then an additional role group is added including the 260686004 |Method (attribute)| with a value of 1193917004 |Flap creation - action (qualifier value)|. The donor site may be stated by the use of 'from x body structure' in the FSN, or if the donor site is indicated by the flap substance (See Example 2 below).

If it is known where on the body the procedure to perform the flap reconstruction, or flap creation, or other flap procedure is performed, then 405813007 |Procedure site - Direct (attribute)| is used (do not use 405814001 |Procedure site - Indirect (attribute)|).
Do not include 405813007 |Procedure site - Direct (attribute)| if no location on the body is specified.
Do not include general value 442083009 |Anatomical or acquired body structure (body structure)| if no body site is stated.

Figure 1: Stated diagrammatic view of 304093002 |Reconstruction using local subcutaneous pedicle osteomyocutaneous flap (procedure)|

Figure 2: Inferred browser view of 304093002 |Reconstruction using local subcutaneous pedicle osteomyocutaneous flap (procedure)|

Figure 3: Stated diagrammatic view of 14390001000004103 |Reconstruction of mouth using pectoralis major myocutaneous flap (procedure)|

Figure 4: Inferred browser view of 14390001000004103 |Reconstruction of mouth using pectoralis major myocutaneous flap (procedure)|

FSN: Reconstruction using flap (procedure)

PT: Reconstruction using flap

SYN: Reconstruction with flap

SYN: Flap reconstruction [optional]

For example,

FSN: Reconstruction using free flap (procedure)

PT: Reconstruction using free flap

SYN: Reconstruction with free flap

SYN: Free flap reconstruction [optional]

FSN: Reconstruction of x body structure using y flap (procedure)

PT: Reconstruction of x body structure using y flap

SYN: Reconstruction of x body structure with y flap

SYN: y flap reconstruction of x body structure [optional]

For example,

FSN: Reconstruction of breast using pedicle transverse rectus abdominis myocutaneous flap (procedure)

PT: Reconstruction of breast using pedicle transverse rectus abdominis myocutaneous flap

SYN: Reconstruction of breast with pedicle transverse rectus abdominis myocutaneous flap

SYN: Breast reconstruction using pedicle transverse rectus abdominis myocutaneous flap [optional]

Existing flap procedure concepts may not align with this new terming. No new ‘flap graft’ procedures should be added going forward.