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.

260686004 |Method (attribute)|

• 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).

405813007 |Procedure site - Direct (attribute)|

• 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.

Example 1: 304093002 |Reconstruction using local subcutaneous pedicle osteomyocutaneous flap (procedure)|

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

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

Example 2: 14390001000004103 |Reconstruction of mouth using pectoralis major myocutaneous flap (procedure)|

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

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

Flap procedure naming

Simple procedure terming

• 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]

Flap reconstruction 2

• 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.

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