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]