Flaps

Question 1

Groin Flap

Answer 1

sCIA off the EIA/superficial femoral
1 finger breadth below inguinal ligament along the axis of inguinal ligament, doppler signal, pinch test for skin, start dissection at the level of the fascia, go below when you see lateral boarder of sartorius….the pedicle is in the femoral triangle bordered by inguinal ligament, arteries and the medial boarder of adductor longs

Question 2

Fibula

Answer 2

inter muscular septum has the perforators, do anterior incision find septum
posterior incision find septum, if no perforators above fascia then keep inter muscular perforators posteriorly for skin flap

if no skin flap make incision 1-2cm below the fibula, remember to leave 6cm distal and 4cm proximal. when you see the lateral compartment via anterior incision and the inter muscular septum, make an incision through the fascia above inter muscular septum. Peel off the peroneus longs off the fibula, leave a cuff of muscle, you will hit the interossus septum, incise, this put you into the posterior compartment. Continue dissecting of tibias posterior, you will see pedicle, find distal pedicle and ligate, take of FHL, then dissection proximally and ligate pedicle

can gain length if you sacrifice bone proximally and elevate the pedicle and increase length

Question 3

Gracilis

Answer 3

axis of muscle is from ischium to medial condyle of femur. 2 cm posterior to the adductor longus. The pedicle is 10cm inferior from ischium. After marking a longitudinal incision I would identify the muscle, incise the fascia, and harvest length of muscle needed. I would trace it back between the adductor longus and gracilis harvesting nerve as needed for functional muscle transfer, and tracing it back,

If i need the full length of the muscle I would harvest the distal pedicles off SFA

Question 4

latissimus

Answer 4

thoracodorsal, sub scapular

have serratus and paraspinal perforators

say boarders of flap

Question 5

ALT

Answer 5

line drawn from ASIS to lateral boarder of patella

The signal is dopplered in the boarder of the proximal and distal thirds

The anterior branch of LFC supplies TFL, descending ALT

The skin paddle designed over doppler signals. You dissect out the anterior incision, can go subfascial, identify all the perforators submusculat vs inter muscular septum. Anterior is rectus femoris, posterior is vastus lateralis. The posterior incision made, similarly look for any intramuscular perforators. If only intramuscular dissect to LFC if not go btw through septum

Question 6

TUG (transverse upper gracilis

Answer 6

harvest with cutaneous perforators

Question 7

DIEP

Question 8

radial forearm

Answer 8

exam preop: handidness, baseline function, allen test, counseling on the defect size

Harvest: supine position, arm abducted to 30 degrees, pneumatic tourniquet, besmirch bandage, design template, center over radial artery start distal, go underneath the antebrachail fascia, leave paratenon on the FCR. ligate the radial artery distally and venocomitante, consider taking cephalic vein if needed for reconstruction. The dissection carried proximally taking care not to injure the superficial radial nerve. ligated proximally after tracing it back under BR

Question 9

FDMA