An adjacent tissue transfer, also known as a rearrangement procedure or simply ATT/R, is a medical procedure wherein flat sections of healthy skin and other tissues are transferred or transplanted to the area adjacent to a skin defect. These sections of tissue are called local flaps and are used to cover up defects or lesions on the surface of the skin. This procedure, which can be performed on any part of the body, including the trunk, scalp, arms, and legs, promises better cosmetic results because the donor skin and the skin immediately surrounding the wound or lesion have the same features.
Patients who should undergo adjacent tissue transfer or rearrangement are those who want to cover up skin imperfections, including:
The procedure is performed mostly for injuries on certain parts of the body, such as the trunk, scalp, legs, and arms, as well as for injuries that are too big that the edges of the wound cannot be sutured or stitched together. The size of the flap taken from the donor site matches the size (both in area and depth) of the wound that has to be covered. The donor site is the same body part, with the flap being taken from the area adjacent to the skin defect that has to be covered up.
The main advantage of an adjacent tissue transfer over skin or tissue graft is that a part of the flap remains connected to its origin. This way, the flap has an intact and continuous blood supply. This means that the tissue will not lose blood supply even while waiting for new blood vessels to grow on the recipient site. A skin graft is a piece of tissue that is separated completely from its origin. Thus, it has to wait for new blood vessels to grow before it can receive a supply of blood again.
Moreover, an adjacent tissue transfer or rearrangement also makes sure that the skin flap used to cover up the skin defect shares the same characteristics, in terms of thickness, colour, and general appearance, with the area around the damaged skin. Thus, the cosmetic results are better than what can be achieved with a skin graft.
Another advantage is that skin flaps heal faster compared to skin grafts. This is partially because the patient only has to heal in one part of the body instead of in two separate sites.
An adjacent tissue transfer or rearrangement is performed in two stages. The first stage is when the local flap is taken from the donor site and sewn into the site where the lesion or skin defect is located. The two sites are connected together by a bridge of tissue called the flap pedicle, which provides continuous blood supply to the local flap for a couple of weeks.
The second stage of the process is when the flap pedicle is cut permanently. This stage is performed only when the flap already receives blood from the recipient site, and thus no longer needs the blood supply from the origin site. Once the pedicle is cut, the tissue repair is complete.
It is normal for patients to experience some tenderness in the surgical site for around 1 to 2 hours after the procedure once the effects of the anaesthesia wear off. Both the origin and wound sites are then covered with a single sterile dressing since they are adjacent to each other. Patients are also advised to refrain from strenuous activities for the first few days after the procedure or until the stitches are removed. This may take anywhere between 5 to 10 days after the procedure.
Patients undergoing an adjacent tissue transfer or rearrangement should be informed of the risks that come with the procedure. These include:
Also, patients should be informed that while an adjacent tissue transfer allows the wound to be closed up, it does not guarantee that the patient will be satisfied with the appearance of the wound after the procedure. In some cases, patients undergo a secondary procedure to improve the appearance of the healed wound.
Ngan V. “Flaps.” DermNet New Zealand. 2007. http://www.dermnetnz.org/topics/flaps/
Hsieh ST. “Free tissue transfer flaps.” Medscape. http://emedicine.medscape.com/article/1284841-overview
Becker FF. “Local tissue flaps in reconstructive facial plastic surgery.” Southern Medical Journal. 1977. 70(6):677-680. http://europepmc.org/abstract/med/327561