Muscle flap surgery wmhs plastic surgery cumberland. It is clear that when muscle is attached to bone, it also provides blood supply. In the event that a latissimus muscle flap is used without a breast implant, risks associated with breast implants would not be applicable. Because of the complexity and variation observed in axial blood supply, a further subclassification axial types iv was made by mathes and nahai and is readily used in plastic and. To assess the results of cases with complex wounds exposing tibia who were managed with distally based random flaps. Get a printable copy pdf file of the complete article 9. Ribpectoralis major osteomusculocutaneous flap plastic. The surgeon must extract and relocate skin, blood vessels, muscle, and fat from one area and relocate it using precision techniques to ensure its survival. The muscle lies in the superficial posterior compartment extending the entire length of the lower leg. 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.
Below knee amputation with extended flap and bone bridge. Perioperative outcomes based on surgical specialty, abstract background. This is done to fill a defect such as a wound resulting from injury or surgery when the. Pdf hemisoleus muscle flap in the reconstruction of exposed. Rather than a distant free flap, it can be used as a local free flap. It is used primarily to provide a wellvascularized soft tissue that is relatively resistant to infection, helps wounds heal, and offers a vascularized surface for skin grafts.
Anterior incision down approx half diameter of limb. The medial gastrocnemius muscle flap is not usually harvested as a free flap. The superior gluteal artery and venae via perforators through the gluteus maximus muscle from internal iliac. Jan 12, 2015 in these cases, the muscle may be employed to restore dynamic function to the paralyzed face. Head and neck reconstruction with the infrahyoid flap in era of free. The study group comprised of 20 patients, both male and. Pdf hemisoleus muscle flap in the reconstruction of. As a muscle flap, it has been used to ensure a rich vascular supply to skin flaps. The flap can be raised up and pedicled only on the coronoid process. Jun 18, 2019 a study by sadigh et al described the effective use of a recycle flap, in which soft tissue is harvested from an existing flap, allowing debulking and refinement of the original flap while creating a second flap that requires no additional donor site. It may be used as a pedicle flap or as a free flap. Pdf the gastrocnemius muscle flap for coverage of soft. The muscle flap is commonly used to eradicate infection and to revascularize bone. However, there is evidence that musculocutaneous flaps can reduce bacterial counts and increase phagocytic activity locally and their use is common place in the management of acute wounds, osteomyelitis and for covering orthopaedic prostheses.
Its major function is the plantar flexion of the foot 3, but when the muscle is cut, it loses its function, being taken over by the gastrocnemius 2, 16. The reach of the gastrocnemius musculocutaneous flap. Kld, i had an ischial muscle flap surgery done on the 4th of this month. Skin and fat from the mid and upper buttock over the gluteus maximus muscle. Gastrocnemius muscle and musculocutaneous flaps are very. May 10, 2015 the present study has provided additional information on the various patterns in the extra muscular part of arterial supply to the soleus muscle. This is critical because the sartorius muscle derives its blood supply medially in a segmental fashion from approximately 5 to 11 vascular pedicles arising from. Azizzadeh has used gracilis free flap treatments as well as nerve transfers to. The lateral gastrocnemius flap is accessed via a longitudinal incision 3 cm posterior to the fibula.
He said about 30% of the muscle had been destroyed, so he put a vac on it. If the blood supply comes from a recognized artery or group of arteries, it is referred to as an axial flap. More recently, a split temporalis muscle flap elevated on the superficial temporal pedicle has been described, for which the resulting gain of length makes crossing of the midline possible, as well as reconstruction of substance losses exceeding the midline. Sartorius muscle flap technique sartorius muscle pain and treatment sartorius flap procedure download here free healthcaremagic app to ask a doctor. Complicated groin wounds often require repair by sartorius muscle flap smf. The bone will bleed from its edges if there is enough vascularized. While it is true that theres usually no discernible muscle weakness after a latissimus flap when doing regular activities, one of its drawbacks is the possibility of animation when the muscle contracts. The present study has provided additional information on the various patterns in the extra muscular part of arterial supply to the soleus muscle. Temporalis muscle flap and temporoparietal fascia flap. 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. The temporalis muscle lies deep to the temporoparietal fascia.
The need, therefore, for such an atlas of muscle and musculocutaneous flaps is immediate and obvious. In the series after 1994, flaps were most commonly used for reconstruction of. The gastrocnemius muscle flap for coverage of soft tissue defect of the proximal third of lower leg. The current authors indication for gluteus maximus transfer is massive gluteus. Jun 26, 2016 the ribpectoralis major osteomusculocutaneous flap has been used to provide replacement for mandibular defects and lining tissue in the oral cavity, especially for reconstruction of the soft palate, floor of the mouth, and lateral pharyngeal wall. Find muscle flap surgery information, treatments for muscle flap surgery and muscle flap surgery symptoms. Gracilis muscle free flap transplant facial paralysis. An external file that holds a picture, illustration, etc. An attempt is made to refine the technique of flap harvestation to optimize.
Azizzadeh has used gracilis free flap treatments as well as nerve transfers to help patients correct their facial paralysis symptoms. Vascularised muscular flaps and arterial graft infection in. Pectoralis major myocutaneous flap and myofascial flap. However, muscle flap selection after failure of treatment with other modalities necessitates diagnosis of the etiology of previous failure. The main indication for anterior gluteus maximus transfer is abductor deficiency secondary to loss of gluteus medius and minimus in the presence of a normal functioning gluteus maximus. Utilized as both local pedicle flaps and free tissue transfers, muscles have been successfully employed to cover complex wounds, manage osteomyelitis, salvage infected vascular grafts, treat recalcitrant venous stasis ulcers, preserve amputation levels, and. Extremity flap reconstruction team orthobullets 4 hand. Then it got infected, so my doctor had to go back in and debreed it.
Boy2 bchd, mchdoral path, phd and gerhard steenkamp1 bsc, bvsc, msc. Lateral gastrocnemius myocutaneous flap transposition to. Case report use of the vastus medialis perforator flap to treat. In these cases, the muscle may be employed to restore dynamic function to the paralyzed face. Technical changes in paraspinous muscle flap surgery have.
Operating surgical specialty differs based on smf indication, hospital, and operating surgeon preference. Muscle flaps have proved to be a valuable and versatile tool in the surgical treatment of the severely compromised lower extremity. Sternal and clavicular head detached from humeral attachments fig. The paraspinous muscle flap is an excellent choice for wound recon. A tecnique to maximise length of pectoralis major muscle. The issues that would negatively impact free flap success should be assessed. Flap surgery is a technique in plastic and reconstructive surgery where any type of tissue is lifted from a donor site and moved to a recipient site with an intact blood supply. If local skin flaps are not an option, muscle flap transpositions which include the vastus medialis, vastus lateralis, sartorius, and gastrocnemius should be considered. Ive had the vac for two weeks now, but not much progress. This anatomic feature allows surgically splitting the muscle for transfer of onehalf the muscle as a flap hemisoleus muscle flaps. Twentytwo patients had paraspinous muscle flap surgery performed using the modified technique and 29 patients had paraspinous muscle flap surgery performed using the classic technique.
Wiley online library will be unavailable on saturday 27th february from 09. Some women who have muscle flap surgery still require a breast implant to achieve the final size and shape that they desire. Free tissue transfers such as the latissimus dorsi, tensor fascia lata, and groin flap are utilized when local muscle flaps are unavailable. In our practice, we rarely use a pedicled medial gastroc. Soleus muscle flap application for reconstruction of the. If some portion of that muscle chosen as the flap and the rest is left intact. 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.
Prior to the development of a wound infection, all patients in the study had undergone spinal fusion with titanium instrumentation. Of all the available donor sites for autologous breast reconstruction, the tram flap in both pedicled and free form is the most frequently used method. 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. Gracilis muscle flap was used for eight patients and latissimus dorsi muscle for. Conclusion the proposed technique is reproducible and reliable and possibly increase the indications of usage of the flap. If adequatelysized perforators are not available, the perforator flap can be converted into a muscle sparing flap as in case of thoracodorsal artery perforator flap or lateral circumflex femoral artery perforator flap as salvage procedure. Bell editorial comment both this and the preceding chapter indicate the interest and study given to the vascularization of the ribs. Feb 18, 2020 the muscle flap uses only muscle for defect coverage. Transposition of the sartorius muscle was originally described in 1948 to cover exposed femoral vessels after inguinal lymph node dissection. Pectoralis major myocutaneous flap and myofascial flap iowa.
And in addition microsurgical techniques can greatly enhance the mobility and length of the flap when used locally. The vascular anatomy of muscle is basically the key to knowledge of blood supply to the skin. The gastrocnemius muscle flap showed good results in the treatment of defects after arthroplasty or arthrodesis of the knee in multimorbid patients. Check out our before and after images to see how dr. Jun 14, 2016 it is a broad, radiating muscle that arises from the temporal fossa and from the deep surface of the temporal fascia. Hemisoleus muscle flap in the reconstruction of exposed bones in the lower limb article pdf available in journal of wound care 2211. This knowledge is important to the plastic and orthopedic surgeons while performing the pedicle flap surgeries. Outcome of primary closure of skin over temporalis muscle flap drawbacks of temporalis muscle flap. Musclesparing and free tram flap breast reconstruction.
Gastrocnemius rotation flap technique orthopaedicsone. Reconstruction after orbital exenteration using gracilis. Split temporalis muscle flap anatomy, vascularization and. Advances in neurosurgical technique, instrumentation for spinal stabilization, and adjuvant therapy allow for a greater number of surgical candidates than ever before. The pedicled soleus muscle flap for coverage of the middle. Separate branches for the medial and lateral gastrocnemius muscles, via the posterior tibial nerve. The muscle flap uses only muscle for defect coverage. Outcome of primary closure of skin over temporalis muscle flap drawbacks of temporalis muscle flap temporal fossa concavity figure 11. Its fibers converge inferiorly to form the tendon, which passes deep to the zygomatic arch and inserts into the medial surface of the coronoid process.
We retrospectively analyzed the medical records of patients undergoing transposition of the medial gastrocnemius and or soleus for treating exposed bone in the leg, from january 1976 to july 2009, gathering information on epidemiological data, the etiology the lesion, the time between the initial injury and muscle transposition, the muscle used to cover the lesion, the healing. Medially this extends down to an inflection at the edge of gastrocnemius muscle. 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. Anatomy of the gastrocnemius muscle everything you need to know dr. Learn vocabulary, terms, and more with flashcards, games, and other study tools. Armed with this information, the trained surgeon can undertake flap transposition with an enhanced degree of safety and reliability. Technical changes in paraspinous muscle flap surgery have increased salvage rates of infected spinal wounds alexander f. A gracilis muscle transplant may help a patient achieve longlasting facial paralysis relief. Muscle flap surgery wmhs plastic surgery cumberland, md. Ischial muscle flap kld, i had an ischial muscle flap surgery done on the 4th of this month.
The vascular supply is the deep temporal artery, which originates from the internal maxillary artery fig. The soleus originates from the posterior surface of the tibia, the interosseous membrane, and the proximal third of the fibula. Despite the advantages of the diep flap, its use for breast reconstruction remains controversial. Breast reconstruction with the diep flap or the muscle. In the middle third of the leg, the muscle joins with the gastrocnemius muscle and is adherent to the calcaneal tendon. Versatility of the free vastus lateralis muscle flap petros k. Microsurgical free muscle flaps for reconstruction of posttraumatic. Depending on the type and degree of abductor deficiency, different abductor repair or transfer techniques are warranted. Broyles introduction radical oncological resection is warranted for aggressive benign tumors and for lowgrade and highgrade malignant tumors of the spine.
C the muscle is rotated 180 on its medial axis, leaving the medial vascular bundles intact. Intraoperative penciltip doppler confirmed the meticulously dissected pedicle, as well as the dorsalis pedis and posterior tibial artery pulses throughout the operation. Vascularised muscular flaps and arterial graft infection. Temporalis muscle flap and temporoparietal fascia flap ento key.
The muscle runs deep to the gastrocnemius muscle in the upper third of the leg. For more than a century, the temporalis muscle has been used for facial reconstructions. Loss of latissimus muscle function there is anticipated loss of normal function in the latissimus dorsi muscle after it is transferred to the chest wall. Pedicle flap definition of pedicle flap by medical. Sep 26, 2016 depending on the type and degree of abductor deficiency, different abductor repair or transfer techniques are warranted. Laterally, this extends down to the posterior edge of fibula.
A novel technique for ventral orbital stabilization. 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. Meland and arnold, in their classic paper, describe the role of muscle flaps in the management of 24 periprosthetic graft infections. The muscle belly is released from the tibia, fibula, and both lateral and anterior crural compartments, while the common peroneal nerve is identified at the level of the fibular neck. Musculocutaneous flaps in head and neck reconstruction.
The tendinous portion is important for securing the flap. Microsurgery can augment medial gastroc use as a local flap by extending the reach of the muscle. There is a major difference between the latissimus and the diep flaps, and that is the incorporation of muscle in the flap. Case example of pectoralis myocutaneous flap general considerations.
Covering of an exposed vascular graft in the groin with an. The technique of sartorius flap creation has been described previously. Gracilis muscle free flap transplant facial paralysis institute. Clinical atlas of muscle and musculocutaneous flaps. The newly inset lateral gastrocnemius myocutaneous flap was then sutured into place with the aid of advancement flaps of the suprapatellar tissue 3cm wide. Muscle flaps have proved to be a valuable and versatile tool in the surgical treatment of the severely. Versatility of the free vastus lateralis muscle flap. The versatility of temporalis myofascial flap in maxillo. Pedicled temporalis muscle flap for craniofacial reconstruct. 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. If some portion of that muscle chosen as the flap and the rest is. All the information, content and live chat provided on the site is intended to be for informational purposes only, and not a. This is distinct from a graft, which does not have an intact blood supply and therefore relies on growth of new blood vessels.