Flap decisions and options in soft tissue coverage of the lower limb. If you continue browsing the site, you agree to the use of cookies on this website. Gracilis muscle free flap transplant facial paralysis institute. The gracilis muscle free flap is generally performed as a 2stage procedure. Trapezius muscle and musculocutaneous flaps plastic surgery key. In the series after 1994, flaps were most commonly used for reconstruction of.
However, to our knowledge there has not been a study on the use of a peroneus brevis muscle flap for foot wounds. Then it got infected, so my doctor had to go back in and debreed it. The sternocleidomastoid muscle has significant application in the head and neck following radical ablative surgery about the mandible, face, and oral cavity. The soleus muscle flap is the workhorse of the central third of the leg, and its blood supply is derived principally from proximal branches of the posterior. Temporalis muscle flap and temporoparietal fascia flap ento key. Muscle flaps mathes and nahai classification for muscle. In the following case study we demonstrate the use of a peroneus brevis muscle flap in coverage of a foot wound. Proceed from inferiormedial to superiorlateral divide insertion only after pedicle is isolated donor site closure direct 57cm. This video demonstrates a medial gastrocnemius rotation flap for soft tissue coverage of the proximal tibia. For the middle tibia, the soleus flap is used, and distal to that a free flap is needed either the medial or lateral heads of the gastrocnemius can be used, though the proximity to the peroneal nerve and its shorter length make the lateral less desirable. The vascular anatomy of muscle is basically the key to knowledge of blood supply to the skin. The need, therefore, for such an atlas of muscle and musculocutaneous flaps is immediate and obvious. Two venae, one usually slightly larger than the artery.
A good option for reconstruction is the use of muscle flaps. In patients with longterm facial paralysis more than 2 years, the native facial muscles are not functional. The sternocleidomastoid muscle flap conley 1980 head. Pectoralis major muscle flaps for closure of sternal defects. Instructions this informedconsent document has been prepared to help inform you of breast reconstruction with latissimus muscle flap surgery, its risks, and alternative treatments. Medial gastrocnemius muscle flap robert ostrum, md on vimeo. C the muscle is rotated 180 on its medial axis, leaving the medial vascular bundles intact. However, about functional loss for higher loads especially in sports activities is reported in the. Several techniques have been developed, including the latissimus and trapezius flaps and the superior gluteal artery flap.
In the following case study we demonstrate the use of a peroneus brevis muscle flap in. Covered successfully with a gastrocnemius muscle flap. The gastrocnemius muscle is routinely used for soft tissue loss and bone coverage over the proximal onethird of the tibia. The tendinous portion is important for securing the flap. The enveloping fascia is divided longitudinally and herniation of the muscle fibres occurs fig. Note the more tendinous nature of the muscle at its most cephalad extent. He said about 30% of the muscle had been destroyed, so he put a vac on it. It provides skin and muscle to cover defects after resection of the temporal bone, in. Latissimus dorsi type v elevation standard muscle flap posterior axillary incision 510cm pedicle in posterior axilla deep to muscle. Trapezius muscle and musculocutaneous flaps plastic surgery. Of all the local rotational flaps, the gastrocnemius is one of the most reliable.
Knowledge of anatomy and surgical technique make the transposition of. The gastrocnemius muscle flap for coverage of soft tissue defect of the proximal third of lower leg. These patients had been treated at the medical college of ohio between 1995 and 1999. Mar 03, 2016 the muscle bulk adequately fills the defect, although globe loss and a color mismatch are apparent. An example of free flap could be a free toe transfer in which the great toe or the second toe is transferred to the hand to reconstruct a thumb. The tibialis anterior used as a local muscle flap over the t. To date, the have been no alternative classification for muscle flaps commonly used in clinical practice. Feb 01, 2010 covered successfully with a gastrocnemius muscle flap. Seven patients with wounds in the middle third of the leg were selected to demonstrate its. It is an axial flap based on the anterior and posterior deep temporal arteries. A foundation explanation of blood supply to muscles and musculocutaneous flaps can be read here. Instructions this informedconsent document has been prepared to help inform you of breast reconstruction with latissimus muscle flap surgery, its.
The medial head originates on the posterior surface of the femur superior to the medial condyle and posterior to the insertion of the adductor magnus muscle. The sartorius is a frequently used muscle flap to cover exposed arterial grafts in the groin. Mathes editorial comment the editors caution the reader to use this flap only when the transverse cervical artery is known to be intact. The flap easily covers the tibial plateau region, and the muscles origin on the distal femur can be released, allowing the reach to be extended to the patella and suprapatellar regions. Separate branches for the medial and lateral gastrocnemius muscles, via the posterior tibial nerve. Pectoralis major myocutaneous flap and myofascial flap see also.
In the lower leg and particularly the tibia, a muscle flap must be well vascularized and durable. Ive had the vac for two weeks now, but not much progress. For the middle tibia, the soleus flap is used, and distal to that a free flap is needed. Soleus muscle flap application for reconstruction of the. The pedicled gastrocnemius muscle flap has been appreciated for its reliable blood supply, easy harvest, and feasible arc of rotation, making it a widely used flap to cover defects in the distal. One of the earliest reports concerned its use as a flap following lymph node dissection in 1948. Reverse peroneus brevis muscle flap for dorsal foot wound. This study aims to evaluate the use of a medial gastrocnemius muscle and or soleus muscle flap as a surgical treatment of the leg bone exposure. We describe a technique for flap harvest to buttress the bronchial stump after lobectomy using video assisted thoracoscopic surgery. Pdf on feb 1, 2017, ingo schmidt and others published the gastrocnemius muscle flap for coverage of soft tissue defect of the proximal third of lower leg find, read and cite all the research. Jan 12, 2015 the advantage of the temporalis muscle flap is the ease of access to the muscle, the moderate quantity of muscle that can be harvested, and the ability to transfer the muscle to the oral cavity.
Methods we conducted a retrospective analysis by active search of medical records of all patients submitted to mobilization of flaps of soleus and gastrocnemius muscles or both to cover the exposure. It has definite advantages over other myocutaneous flaps used in this region. Jun 24, 2019 the gracilis muscle free flap is generally performed as a 2stage procedure. Gracilis vessels from the medial femoral circumflex system. Pectoralis major myocutaneous flap and myofascial flap iowa. Microsurgery can augment medial gastroc use as a local flap by extending the reach of the muscle. Kld, i had an ischial muscle flap surgery done on the 4th of this month. Pdf the gastrocnemius muscle flap for coverage of soft.
The intent of the procedure is to prevent the cancer from spreading to lymph nodes and other organs of the body. Vascularised muscular flaps and arterial graft infection in. For the dermal closure of the implanted muscle flap, splitskin meshgraft with a thickness of 0. Armed with this information, the trained surgeon can undertake flap transposition with an. Muscle flap salvage of spine wounds with soft tissue defects. Use of local muscle flaps to cover leg bone exposures discussion the treatment of skin loss resulting from traumatic, infectious and vascular ulcerations processes is a challenge for surgeons and often requires the assistance of specialized techniques of plastic surgery and microsurgery.
Soft tissue defect of the lower leg with exposure of bone, tendon, and osteosynthesis plates or total knee artthroplasty is a challenging therapeutic problem. The pediculated gastrocnemius muscle flap as a treatment for. Jan 09, 2012 the muscle belly should be lifted without a skin graft because this could cause problems with the closure of the skin near the location of extraction. Local flap necrosis is an important complication of the bipedicle abdominal flap. Like the tpff, the tmf is a reliable, myofascial flap that was also described more than a century ago. The temporalis muscle is found deep to the temporalis muscle fascia. In the event that a latissimus muscle flap is used without a breast implant, risks associated with breast implants would not be applicable. The advantage of the temporalis muscle flap is the ease of access to the muscle, the moderate quantity of muscle that can be harvested, and the ability to transfer the muscle to the oral cavity. Pdf on jan 1, 2017, ingo schmidt and others published the role of gastrocnemius muscle flap for reconstruction of large soft tissue defects after infected total knee arthroplasty find, read. No bone grafts, omentum flaps or skin grafts have been needed in more than 20 patients.
A majority of soleus muscle fibers originate from each side of the anterior aponeurosis, attached to the tibia and fibula. This retrospective study was designed to analyze the results of 22 patients treated for postoperative soft tissue defects of the spine. Medial gastrocnemius muscle flap robert ostrum, md on vimeo join. The muscle bulk adequately fills the defect, although globe loss and a color mismatch are apparent. Muscle flap surgery wmhs plastic surgery cumberland, md. Jun 26, 2016 trapezius muscle and musculocutaneous flaps k. Indeed, controversy exists about the flap s interference with an oncologically sound neck dissection a total of 21 patients with oral cavity cancers over a three year period were. The gastrocnemius muscle flap has proven to be a suitable and reliable option for coverage of soft tissue defects after tka or posttraumatic conditions, and it is probably one of the safest flaps. Indications the gastrocnemius muscle is routinely used for soft tissue loss and bone coverage over the proximal onethird of the tibia. Pectoralis major myocutaneous flap in head and neck surgery. However, its role in composite defects involving the jaw is not clearly defined. The transverse cervical artery often is ablated during a radical neck dissection. The muscle component of the flap allows for obliteration of 3dimensional defects. The gastrocnemius muscle flap is one option for coverage.
The paraspinous muscle flap is an excellent choice for wound recon. Use of local muscle flaps to cover leg bone exposures. Dec 31, 2016 alternatively, a turnover flap can be performed by making the initial fascial incisions on the lateral aspect of the erector spinae fascia, elevating the muscle groups from lateral to medial preserving the medial perforator row, and transposing the lateral edges of bilateral muscle flaps toward the midline. I was 33 years old then and a little overweight which turned out to be a good thing, because i had just the right amount of fat on my lower abdomen to do the reconstruction. The vascular supply is the deep temporal artery, which originates from the internal maxillary artery fig. This flap is probably one of the safest flaps, and relatively easy to dissect. The submental flap is gaining popularity as a simple technique for reconstruction of small to moderate size defects of the oral cavity. Videoassisted harvest of an intercostal muscle flap ctsnet. Slideshare uses cookies to improve functionality and performance, and to provide you with relevant advertising. Case example of pectoralis myocutaneous flap general considerations. Clinical atlas of muscle and musculocutaneous flaps. Though success will largely depend on the extent of a patients injury, flap surgery and microsurgery have vastly improved a plastic surgeons ability to help a severely injured or disfigured patient. It can be harvested with a skin paddle see tug flap. It can be used in the following ways to rehabilitate the paralyzed face, to correct a softtissue defect about the upper neck and oral cavity, and to protect the major arteries in the head.
With latissimus muscle flap page 1 of 8 patient initials 050105 version 2005 american society of plastic surgeons. The authors divided the cases into two seriesbefore and after 1994because, after 1994, they started to perform free flap reconstructions, and indications for reconstruction with a temporalis muscle flap were changed results. Indications the pectoralis major myocutaneous flap and myofascial flap variation are utilized in a large variety of head and neck reconstructive procedures that can include coverage of mucosal andor cutaneous defects. B the muscle is mobilized along its lateral edge to the anterior superior iliac spine. The muscle belly should be lifted without a skin graft because this could cause problems with the closure of the skin near the location of extraction. Dec 20, 2011 the submental flap is gaining popularity as a simple technique for reconstruction of small to moderate size defects of the oral cavity. Muscle flap surgery a mastectomy is a necessary, yet often times traumatic, surgery that removes one or both breasts of a woman who has cancerous tumors. Deep relations of pectoralis major muscle blood supply of pectoralis major flap figures 2, 3 the pectoralis major flap is an axial flap.
A muscle flap is indicated when vital structures such as bones, joints, tendons, or hardware are exposed and require coverage. I had the bilateral tram flap reconstruction immediately after my bilateral mastectomy in nov. Latissimus dorsi muscle pedicle flap was used for coverage of the lateral epicondyle area. Jun 14, 2016 the temporalis muscle is found deep to the temporalis muscle fascia. Gastrocnemius rotation flap technique orthopaedicsone. Pedicled thoracic myoplasty, a simple and robust technique to bring vascularized tissue into the chest cavity, is performed to ad dress space issues or to buttress. Maxillectomy without orbital exenteration and large neck defects are other possible applications for this flap. Various types of tissue may be transferred as a free flap including skin and fat, muscle, nerve, bone, cartilage or any combination of these, lymph nodes and intestinal segments. A transplanted muscle from the groin gracilis muscle is necessary if one desires to create a natural and spontaneous facial movement. Utilized as both local pedicle flaps and free tissue transfers, muscles have been successfully employed to cover complex wounds, manage osteomyelitis, salvage. Use of local muscle flaps to cover leg bone exposures scielo. Alternatively, a turnover flap can be performed by making the initial fascial incisions on the lateral aspect of the erector spinae fascia, elevating the muscle groups from lateral to medial preserving the medial perforator row, and transposing the lateral edges of bilateral muscle flaps toward the midline.
Jun, 2016 a muscle flap is indicated when vital structures such as bones, joints, tendons, or hardware are exposed and require coverage. Pedicled temporalis muscle flap for craniofacial reconstruct. Transposition of the sartorius muscle was originally described in 1948 to cover exposed femoral vessels after inguinal lymph node dissection. Technique of muscle flap harvest for intrathoracic use core. Pdf gastrocnemius muscle flap and its application in lower. Soleus muscle flap application for reconstruction of the middle. Because of the limited length of the muscle, and the arc of rotation needed to reach the maxilla, the flap can be brought into the oral cavity by two. Indeed, controversy exists about the flaps interference with an oncologically sound neck dissection a total of 21 patients with oral cavity cancers over a three year period were.
A reliable and simple technique involving the use of pectoralis major muscle flaps is described for the closure of sternal and costal cartilage defects caused by debridement for chronic osteomyelitis following median sternotomy. This is gastrocnemius flap by data trace publishing company on vimeo, the home for high quality videos and the people who love them. The intercostal muscle is a reliable buttress for the bronchial stump following pneumonectomy and lobectomy in high risk patients. After the debridement of devitalized tissues, the best choice for covering the defects was the soleus flap. To create the single pedicled nasalis myocutaneous flap, the triangular flap is first defined. Technical changes in paraspinous muscle flap surgery have. The aim of this study is to analyze a case series of wounds in the middle third of the leg, using soleus muscle flap for reconstruction and evaluating its effectiveness. Pedicle flap definition of pedicle flap by medical dictionary. The gracilis muscle is located in the inner aspect of the thigh. The pectoralis major myocutaneous flap is an axial flap which is versatile, reliable and permits reconstructive surgery for head and neck cancer as a primary procedure. In 1990, obrien was the first to report the use of the gracilis free flap for singlestage facial reanimation. The gastrocnemius muscle flap for reconstruction of the.
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