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PRS > Flaps > Flashcards

Flaps Flashcards

1
Q

Scalp

A 
Scalp rotational
TPF 
Trap
------
ALT
Latiss
Rectus
Omentum
------
1. Superficial temporal 
2. Facial
3. Occipital
4. External jugular vein 
5. Internal jugular vein
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2
Q

Nose

A

Tip:

  • bilobed flap
  • dorsal nasal flap

Sidewall:
<1cm → primary closure.
1-1.5cm → bilobed flap,
>1.5cm → forehead flap

Dorsum:
-forehead flap, dorsal nasal flap, FTSG

Total nasal recon → 2 stage: FRF lining, ear cartilage support, forehead flap coverage.
- 1st is FRF with extra fascia extension, fascia is lining. 2nd stage rib cartilage is used as cantilever dorsal nasal graft and BL conchal alar batten grafts for alar support, then fold flap (with skin paddle over cartilage. 2nd stage remove majority of skin paddle but leave lining and add cartilage and cover with forehead flap.

\_\_\_\_\_\_
Forehead flap
Nasolabial
\_\_\_\_\_
FRF
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3
Q

Ear

A

Rim:
-1cm or less → Primary closure.
-2cm or less: Antia buch
Dissect skin off cartilage in front of ear and completely posteriorly as well. Ie just move soft tissue around the cartilage framework which doesn’t move

Middle ear:
-<2cm: Postauricular island flap (flip-flop):
raise flap from retroauricular area down through muscle to fascia, then raise up and suture into defect. Leave pedicle at inferior aspect of flap intact .
->2cm: TPF + STSG

Total ear recon (microtia):
Nagata 2 stage technique.
-Harvest ribs 6-9 and make ear, then place into skin pocket. Come back for 2nd stage (ear projection stage)→ raise skin / cartilage construct, then use pedicled TPF flap to cover posterior cartilage and take new rib cartilage block to place behind ear for projection. Then STSG over TPF flap.

________

  1. Superficial temporal
  2. Facial
  3. Lingual
  4. Superior thyroid
  5. External carotid
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4
Q

Tongue

A 
Primary closure
\_\_\_\_
FRF
VRAM
ALT 
\_\_\_\_
(non workhorse pedicled: pec major, deltopectoral, supraclavicular)
\_\_\_\_\_\_
1.   Superficial temporal  2.   Facial 
3.   Lingual 
4.   Superior thyroid 
5.   External carotid
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5
Q

Lip

A 
Upper:
  - <1/3: close
  - >2/3: 
        - Abbe (philtrum)
        - Advancement w/ burrows (mid lat)
        - Estlander (commissure)
   - Total: 
        - Bernard Burrow
        - Gracillis --> marge +STSG or FAMM (lining) 
        - FRF with PL (static)
Lower:
  - <1/3: close
  - 2/3: Karapandzic, Abbe, Estlander (comm)
  - Total: same ^^

______

  1. Superficial temporal 2. Facial
  2. Lingual
  3. Superior thyroid
  4. External carotid
  5. Transverse cervical
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6
Q

Cheek

A

Cervicofacial
Nasolabial

(others:
Deltopectoral
Supraclavicular)

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7
Q

Intraoral

A

Pec Major
FRF

(others:
tongue, FAMM, supraclavicular, deltopec, nasolabial)

____

  1. Superficial temporal 2. Facial
  2. Lingual
  3. Superior thyroid
  4. External carotid
  5. Transverse cervical 7. External jugular vein 8. Internal jugular vein
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8
Q

Skull base

A

Temporalis
TPF
Free muscle + skin

_____

  1. Superficial temporal 2. Facial
  2. Lingual
  3. Superior thyroid
  4. External carotid
  5. Transverse cervical 7. External jugular vein 8. Internal jugular vein
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9
Q

Neck

A 
Pec major
Supraclavicular
Deltopectoral
Submental
Trap
Latissimus
\_\_\_\_\_\_
ALT
FRF
Jejunal

_______

  1. Superficial temporal 2. Facial
  2. Lingual
  3. Superior thyroid
  4. External carotid
  5. Transverse cervical
  6. Thoracoacromial
  7. Cephalic vein turnover
  8. External jugular vein 10. Internal jugular vein
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10
Q

Shoulder

A 
Latiss
Pec Major
Scapular / Parascap
\_\_\_\_
Free flap

(Others: Trap, Serratus muscle, Intercostal a perforator)
______
1. Thoracodorsal
2. Thoracoacromial
3. Lateral thoracic
4. Axillary
5. Circumflex scapular 6. Transverse cervical 7. Cephalic vein

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11
Q

Axilla

A

Latissimus
Scap / parascap

(others: intercostal a perf, lat arm, serratus m)
______
1. Thoracodorsal
2. Axillary
3. Circumflex scapular 4. Lateral thoracic
5. Brachial
6. Transverse cervical 7. Cephalic vein

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12
Q

Upper arm

A

Latiss
Scapular / Parascap
__
Free flap

Others: lat arm, RF
\_\_\_\_\_
1.   Brachial 
2.   Posterior circumflex humeral 
 3.   Superior ulnar collateral 
4.   Radial collateral 
5.   Cephalic vein 
6.   Basilic vein
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13
Q

Elbow

A

Reverse lat arm
RF

Others: Latiss, FCU (ulnar a perfs), ulnar forearm, Groin
\_\_\_\_\_\_\_\_
1.   Brachial 
2.   Radial 
3.   Ulnar 
4.   Cephalic vein
5.   Basilic vein
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14
Q

AC fossa

A

Reverse lat arm
RF

Others: FCU, ulnar forearm
\_\_\_\_\_\_
1.   Brachial 
2.   Radial 
3.   Ulnar 
4.   Cephalic vein
5.   Basilic vein
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15
Q

Forearm

A

RF

Others: Ulnar forearm, Rev lat arm, PIA, groin, BR
\_\_\_\_\_
1.   Radial 
2.   Ulnar 
3.   Cephalic vein 
 4.   Basilic vein
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16
Q

Wrist

A

Rev RF
PIA

Others: groin, ulnar forearm, BR
\_\_\_\_\_\_
1.   Radial  
2.   Ulnar 
3.   Cephalic vein  
4.   Basilic vein
17
Q

Hand (dorsal, volar to MP, webspaces)

A 
Dorsum: 
   - small: rotational, rhomboid
   - large: Rev RF, PIA, Groin
Volar:
   - Groin
Webspaces: 
   - 1st: F lat arm
   - 2-5: Rev dorsal MC a 
\_\_\_\_\_\_\_\_\_
FRF
Latiss
F lat arm
18
Q

Fingers (distal to MP, digits 2-5, volar vs. dorsal)

A

Volar

  • tip:
    • Atasoy (dorsal oblique, transverse)
    • Cross finger (DP + MP)
    • Thenar (volar oblique)
    • Tegaderm
    • Rev homodigital Island
  • prox:
    • Cross finger (DP + MP)
    • Homodigital island

Dorsal

  • tip: same^^
  • prox:
    • Rev cross finger (MP + PP)
    • Homodigital island
    • Rev dorsal MC a (PIP is distal limit)
19
Q

Thumb (tip vs. MP level vs. CMC level)

A

Thumb: need ⅔ length of proximal phalanx for function. 40% function of hand.
- Tip:
- Tegaderm (<1.5cm)
- Moberg (<2cm), O’brien modification
- FMDA (>2cm)
- Littler (ulnar side of 4th digit)
- MP level:
-T2T
- Osteoplastic: Chest tube filled with
methylmethacrylate, then cut off tube, then groin
flap same day, then come back and place iliac
crest bone graft and plate in place of meth.
Then littler later.
- MC distraction osteogenesis: ( Matev, Sofia,Bulgaria)
gain 3cm bone. Need ⅔ native MC length.
- CMC level:
- Pollicisization
- Groin flap all levels

20
Q

Anterior Chest

A

Pec Major
Rectus
Latiss
Omentum

(others: external oblique, intercostal a perf, serratus, deltopec)
\_\_\_\_\_\_
Free flap
\_\_\_\_\_\_
1.   Internal mammary 
2.   Transverse cervical  3.   Thoracodorsal 
4.   Thoracoacromial  
5.   Axillary 
6.   External jugular turndown  
7.   Cephalic turnover 
8.   Lateral thoracic vein
21
Q

Breast

A

Latiss
TRAM
______
DIEP/TRAM/SIEA

(others: pec major, free TUG / SGAP)
\_\_\_\_\_\_\_
1.   Internal mammary 
2.   Thoracodorsal 
3.   Serratus branch, thoracodorsal  
4.   External jugular turndown 
5.   Cephalic turnover 
6.   Transverse cervical 
7.   Thoracoacromial 
8.   Axillary 
9.   Lateral thoracic vein
22
Q

Chest Wall

A

Lining: ADM
Fixation:
-Nonrigid: <4 ribs or <5cm, defect posterior beneath
scapula Muscle or musculocutaneous flaps.
- Semi rigid: same as above. Mesh (synthetic or
bioprosthetic).
- Rigid: if > 4 ribs resected or >5 cm defect. Defect is
anterior or lateral chest wall. Have CT do this.
Spanning plates or Polymethylmethacrylate
sandwich with polypropylene mesh on either side.
Coverage:
- TRAM / VRAM, Latiss, pec major (turnover / advancement), serratus, omentum
- Free DIEP, Latiss, ALT
______________
1. Internal mammary
2. Thoracodorsal
3. Thoracoacromial
4. Transverse cervical
5. Cephalic vein turnover
6. Lateral thoracic vein

23
Q

Abdomen

A

TFL
Rectus Femoris
ALT

Others: Rectus abdominis, SIEA, External oblique, Omentum

______

  1. Deep inferior epigastric
  2. Superficial epigastric
  3. Superior epigastric
  4. Superficial circumflex iliac
  5. Deep circumflex iliac
  6. Right and left epiploic
  7. Greater saphenous vein turnover
24
Q

Groin

A

Sartorius
TFL
Rectus Femoris

Others: ALT, Vastus, Rectus abdominis, Gracilis
\_\_\_\_\_\_\_
1.   Deep inferior epigastric  
2.   Superficial epigastric 
3.   Superficial circumflex iliac 
 4.   Deep circumflex iliac 
5.   Femoral 
6.   External iliac 
7.   Greater saphenous vein turnover
25
Q

Vaginal vault

A

Rectus
Singapore (pudenal-thigh)

Others: gracilis, ALT, groin, SIEA, jejunal
\_\_\_\_\_\_\_\_
1.   Deep inferior epigastric 
 2.   Superficial epigastric 
3.   Superficial circumflex iliac 
 4.   Deep circumflex iliac 
5.   Femoral 
6.   External iliac 
7.   Greater saphenous vein turnover
26
Q

Back (upper vs. lower)

A 
Upper:
 - Latiss
 - Scapular
 - Paraspinous
Others: trap, intercostal a per
\_\_\_\_\_\_
1.   Thoracodorsal 
2.   Circumflex scapular  3.   Intercostal artery 
4.   A-V loop (axilla, neck)
Lower: 
  -Latiss
  -Paraspinous
Other: lumbar perf, glut max, external oblique
\_\_\_\_\_\_\_\_
1.   Superior gluteal 
2.   Inferior gluteal 
3.   Intercostal artery 
4.   A-V loop (groin, thoracodorsal)
27
Q

Butt

A 
Glut max
Biceps Femoris
Others: TFL, gracillis, gluteal thigh, vastus
\_\_\_\_\_\_
1.   Superior gluteal  
2.   Inferior gluteal  
3.  A-V loop (groin)
28
Q

Thigh

A 
Sartorius
Gracilis
TFL
Rectus femoris
Vastus
Biceps femoris
ALT
\_\_\_\_\_\_\_
1.   Superficial femoral 
2.   Lateral circumflex femoral 
 3.   Medial circumflex femoral  
4.   Superficial epigastric 
5.   Superficial circumflex iliac 
 6.   Profunda femoris 
7.   Greater saphenous vein
29
Q

Knee

A

Gastroc

Others: rev ALT, rev vastus lateralis, rectus femoris 
\_\_\_\_\_\_\_\_
1.   Popliteal 
2.   Sural 
3.   Genicular 
4.   Descending lateral circumflex  
5.   Superficial femoral 
6.   Greater saphenous vein  
7.   Lesser saphenous vein
30
Q

Leg

A 
Prox 1/3:
 - Gastroc
Middle: 
  - Soleus, regional FC flap (AT, PT, peroneal)
Distal: 
  - FF, other: ant tib, reverse sural 
\_\_\_\_\_\_
1.   Posterior tibial  
2.   Anterior tibial  
3.   Peroneal 
4.   Popliteal 
5.   Dorsalis pedis 
6.   Greater saphenous vein  7.   
Lesser saphenous vein
31
Q

Foot

A

Heel: Reverse sural, medial plantar artery flap (off PT), free muscle (gracilis)

Lateral: Lateral calcaneal (lat calcaneal a from Peroneal a )

Dorsum: dorsalis pedis

_______

  1. Dorsalis pedis
  2. Anterior tibial
  3. Posterior tibial
  4. Peroneal
  5. Greater saphenous vein
  6. Lesser saphenous vein
32
Q

Eyelid

A

Partial thickness: <50% primary closure, >50% FTSG contralat lid

FT:
25% - [Both] primary closure +/- canthot + cantholysis

50%
UPPER –> cutler beard bridge flap + conchal cartilage
(ie separate lamellae of flap and put catilage between. Incision is 4mm from lower lid margin, ie no tarsus included as its 4mm on lower.)
LOWER –> Hughes tarsoconjuctival flap + FTSG
(ie start incision 4mm from upper lid margin as to include 6mm of tarsus with flap as its 1cm on upper lid)

75% - [Both] Fricke flap + hard palate mucosal graft
(leave periosteum down when harvesting)

100% - [Both] contralateral forehead flap with hard palate muscosal graft (ok to take 2 big strips for both lids if you need. Leave strip of palate intact between. No size limit per MN)

33
Q

PS (Ischial, sacral, troch)

A

Ischial:
-inferior gluteal rotational, TFL, posterior thigh V-Y (hamstring musculocutaneous or FC)

Sacral:
- Glut max V-Y, sup gluteal rotation flap, SGAP, TFL, paraspinal transposition flap

Troch:
- TFL, SCIP, ALT, Rectus femoris, +/- Girdlestone (proximal femurectomy and obliteration of dead space with vastus lateralis)

PRS (3 decks)

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