Flap procedures
This Editorial Guide is used for Education Purposes Only. It is used in the Authoring Courses and Certifications. It is based on the January 2026 Editorial Guide.
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)|
Example 2: 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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