In this week's edition
- ✍️ Letter from P'Fella
Stay tuned for: AI surgical studio. - 🤓 The Sunday Quiz
How well do you know rotation flaps? - 🖼️ Image of the Week
Featured: Keystone flap for defect reconstruction. - 🚑 Technique Tip
Principles of effective design for a rotation flap. - 🎓 The Fellow's Corner
The role of TXA in plastic and reconstructive surgery. - 📖 What Does the Evidence Say
Why does pincushioning occur in local flaps? - 🔥 Articles of the Week
Zitelli's original bilobed flap, original keystone flap publication & an overview of local flaps: with 1-sentence summaries. - 💕 Feedback
Suggest ideas & give feedback!
A Letter from P'Fella
Stay Tuned for: AI Surgical Studio!
👋
Hey Team!
Surgical planning just got a major upgrade. AI Surgical Studio is live, and it’s built for the way surgeons think, plan, and refine their techniques.
Surgical planning just got a major upgrade. AI Surgical Studio is live, and it’s built for the way surgeons think, plan, and refine their techniques.
This isn’t just a drawing tool—it’s a surgical studio with precision controls, AI-powered feedback, and seamless workflow integration. Whether you’re mapping incisions, planning complex reconstructions, or prepping for exams, this changes the game.
We’ve combined pro-grade drawing tools with AI-driven analysis to bring surgical planning into the future:
- Flawless Freehand & Incision Planning – Draw, erase, and refine with pixel-perfect accuracy.
- Real-Time Measurements – Ruler & angle tools ensure precision at every step.
- AI-Powered Second Opinion – Get instant feedback on incision placement, symmetry, and design.
- Smart Layer Management – Organize complex surgical plans effortlessly.
Right now, Freestyle Mode is fully functional—giving you complete control to map out all the key flaps, incisions, and surgical plans you need to prepare for. But we’re not stopping here - coming soon:
- Guide Mode – Assisted drawing with structured overlays and real-time AI adjustments to refine every step.
- Exam Mode – A challenge-based system to test your decision-making and technique under pressure, perfect for trainees and board prep.
Want Early Access? Join the Waitlist
We’re building this for surgeons, not just artists. Sign up for the waiting list now to be the first to access Guide Mode & Exam Mode before the full release.
P’Fella ❤️
The Sunday Quiz
How Well Do You Know Rotation Flaps?
Are you ready to make it to the leaderboard?
Welcome to the final round of The Weekly Quiz.
Each edition of thePlasticsPaper includes a quiz question designed to challenge and engage our readers. Keep your wits about you and join in every week — the winner at the end of six rounds will earn you a one-year subscription to thePlasticsPro.
Welcome to the final round of The Weekly Quiz.
Each edition of thePlasticsPaper includes a quiz question designed to challenge and engage our readers. Keep your wits about you and join in every week — the winner at the end of six rounds will earn you a one-year subscription to thePlasticsPro.
Image of the Week
Keystone Flap
🖼️
Image of the Week
In this section, we feature an anatomical illustration. This week’s image highlights the keystone flap, a reliable local flap for defect reconstruction.
In this section, we feature an anatomical illustration. This week’s image highlights the keystone flap, a reliable local flap for defect reconstruction.
Technique Tip
How to Design a Rotation Flap
🚑
Technique Tip of the Week
This week, we’re focusing on rotation flaps, a fundamental technique for closing circular defects with minimal tension.
🔹 Key principle: The flap should be at least 4x the defect radius to allow adequate mobilization.
🔹 Pivot point: Strategically placed to maximize tissue movement while preserving vascularity.
🔹 Back-cut: Used sparingly to gain additional length but should be avoided if possible to maintain perfusion.
Effective rotation flap design ensures optimal contour and tension-free closure.
This week, we’re focusing on rotation flaps, a fundamental technique for closing circular defects with minimal tension.
🔹 Key principle: The flap should be at least 4x the defect radius to allow adequate mobilization.
🔹 Pivot point: Strategically placed to maximize tissue movement while preserving vascularity.
🔹 Back-cut: Used sparingly to gain additional length but should be avoided if possible to maintain perfusion.
Effective rotation flap design ensures optimal contour and tension-free closure.
the Fellows' Corner
The Role of TXA in Plastic and Reconstructive Surgery
📽️
Role of Tranexamic Acid (TXA) in Plastic and Reconstructive Surgery: A National Perspective
In case you missed it: Dr. Hatan Mortada explores the role of TXA in plastic surgery in our latest JPRAS-partnered journal article. Read it here👇
In case you missed it: Dr. Hatan Mortada explores the role of TXA in plastic surgery in our latest JPRAS-partnered journal article. Read it here👇
Role of Tranexamic Acid (TXA) in Plastic and Reconstructive Surgery: A National Perspective
TXA is widely used in plastic surgery, especially in facelifts (83.6%) and rhinoplasty (55.0%), reducing bleeding (61.8%) and bruising (63.2%). Common methods include 1 g IV bolus or 3% topical solution, with 92.4% reporting no complications. Despite benefits, standardization is needed.
PlasticsFella
What Does the Evidence Say?
Why Does Pincushioning Occur in Local Flaps?
In this section, we dive deep into the latest research and evidence on medical practices and surgical techniques.
Pincushioning, or the trapdoor effect, is a common complication in transposition flaps, particularly in nasal reconstruction. It occurs due to contraction of the flap over the wound bed, leading to poor aesthetic outcomes (Kaufman et al., 1993; Okland et al., 2020).
Several factors contribute to pincushioning, including lack of tissue undermining, scar contracture, and biomechanical factors specific to the nasal region (Kaufman et al., 1993; Amici, 2014). Prevention techniques include wide tissue undermining, thinning of excess subcutaneous tissue, and primary lobe pexing sutures (Kaufman et al., 1993; Okland et al., 2020; Boylan et al., 2021). Intraoperative triamcinolone injections have shown limited effectiveness (Boylan et al., 2021). Early corticosteroid injections at the first signs of hypertrophy can be an effective treatment (Amici, 2014).
Proper flap design, delicate tissue handling, and tension-free closure are crucial in reducing complications (Woodard, 2013; Zitelli, 1989; Hom & Ostrander, 2023).
Several factors contribute to pincushioning, including lack of tissue undermining, scar contracture, and biomechanical factors specific to the nasal region (Kaufman et al., 1993; Amici, 2014). Prevention techniques include wide tissue undermining, thinning of excess subcutaneous tissue, and primary lobe pexing sutures (Kaufman et al., 1993; Okland et al., 2020; Boylan et al., 2021). Intraoperative triamcinolone injections have shown limited effectiveness (Boylan et al., 2021). Early corticosteroid injections at the first signs of hypertrophy can be an effective treatment (Amici, 2014).
Proper flap design, delicate tissue handling, and tension-free closure are crucial in reducing complications (Woodard, 2013; Zitelli, 1989; Hom & Ostrander, 2023).
Articles of the Week
3 Interesting Articles with 1 Sentence Summaries
✅
Zitelli’s Original Publication on Bilobed Flaps for Nasal Recon (Zitelli, 1989)
The bilobed flap is a versatile technique for reconstructing defects in the lower third of the nose, reducing pincushioning and optimizing contour by refining transposition angles.
The bilobed flap is a versatile technique for reconstructing defects in the lower third of the nose, reducing pincushioning and optimizing contour by refining transposition angles.
✅
Original Publication on the Keystone Design Perforator Island Flap (Behan, 2003)
The Keystone Design Perforator Island Flap (KDPIF) is a versatile, vascularized local flap that minimizes skin grafting and achieves high primary wound healing rates, making it a reliable option for reconstructing skin defects.
The Keystone Design Perforator Island Flap (KDPIF) is a versatile, vascularized local flap that minimizes skin grafting and achieves high primary wound healing rates, making it a reliable option for reconstructing skin defects.
✅
Techniques and Applications of Local Flaps and Pedicled Perforator Flaps (Miranda, 2013)
Local perforator flaps offer a versatile reconstructive option by preserving vascular perforators, enabling tissue transfer with minimal donor-site morbidity, superior color and texture match, and primary closure.
Local perforator flaps offer a versatile reconstructive option by preserving vascular perforators, enabling tissue transfer with minimal donor-site morbidity, superior color and texture match, and primary closure.
