Flaps Flashcards
Sartorius
Type four, superficial femoral artery and vein
Gastrocnemius muscle
Sural Arteries type one
Lateral arm flap
Posterior radial collateral
Pedicle is located through the lateral intermuscular septum between the brachialis and the lateral head of the triceps
Radial forearm flap pedicle
Between brachial radialis and FCR
Gracilis
Type two
Medial femoral circumflex
Superficial femoral
Rectus femoris
Lateral femoral circumflex artery
Groin flap
Superficial circumflex iliac
Gluteal Thigh flap
Inferior gluteal
What nerve provides sensation to the lateral arm flap
Posterior brachial cutaneous
Triangular space boundaries
Teres minor
Major
Long head of triceps
What does the saphenous artery originate from?
Genicular
Deltopectoral flap
First, second and third perforating branches of the internal mammary artery
Posterior thigh flap
Involves the biceps femoris, semi tendinosis and semimembranosus
Inf gluteal artery
Profunda femoris
Latissimus dorsi
Thoracodorsal
Type five
Soleus
Popliteal
Type 2
External oblique
Lateral cutaneous branches of the inferior eight posterior intercostal arteries
Quadrangular space
Long head of triceps
humerus
Teres minor
Teres major
Contains the posterior circumflex, humeral vessels, and axillary nerve
Pec major
Type V
Pectoral branch of thoracoacromial artery
Abductor digiti minimi
Deep Palmer artery from ulnar artery
Reverse sural flap
Median superficial sural artery
Distal perforating branches of the peroneal
Medial plantar perforator flap
Septum between abductor hallucis and flexor digitorum brevis
Soleus
The proximal muscle is supplied by branches of the perineal artery, and the distal muscle is supplied by the posterior tibial artery perforators
What is the salvage rate for flaps that require re-exploration for ischemia?
50 to 85%
What is the maximum warm ischemia time tolerated by bone flaps?
Less than three hours
What is the maximum warm ischemia time tolerated by skin and fascio cutaneous flaps?
4 to 6 hours
What is the warm ischemia time tolerated by jejunal flaps?
Less than two hours
Mechanism of action of Papaverine
It is an opium alkaloid drug that inhibits phosphodiesterases leading to increase levels of cyclic AMP
How long before a pseudo intima forms at the anastomosis site
Five days
What does heparin do?
Inhibit antithrombin three which inhibits thrombin, and it also inhibits the conversion of fibrinogen into fibrin
How does aspirin prevent platelet aggregation?
Inhibits endothelial Cox pathway with subsequent blockage of thromboxane A2
What are risk associated with using streptokinase?
Bleeding and hematoma
It is antigenic and can result in an allergic response
Can also cause a lytic state which will cause diffuse bleeding when administered in high doses
What nerve provides sensation to the lateral arm
Posterior brachial cutaneous
The fibula and radial forearm Osteo cutaneous flap can provide how much length of bone
Fibula can provide 25 cm
Radius can provide 10 cm
What is the source of free radicals in the ischemic flap?
Xanthene oxidize
What is the blood supply of the Delto pectoral flap?
First, second and third perforating branches of the internal mammary artery
Where does the gluteus maximus insert?
Greater trochanter of the femur
What are the boundaries of the quadrilateral space?
Teres minor superiorly
Teres major inferior
Humerus lateral
Long head of triceps medial
Posterior circumflex, humeral vessels and axillary nerve travel here
What is the blood supply of a nasolabial flap?
Angular artery from the facial artery
Blood supply of the Abductor digiti minimi flap
Deep Palmer artery from the ulnar artery
Blood supply to the reverse sural flap
Peroneal artery more distally and the posterior tibial artery
What is the origin of the TFL flap?
Anterior 5 cm of the outer portion of the iliac crust and ASIS
What is the course of the radial collateral artery to the lateral arm flap?
Through the lateral intermuscular septum between the brachialis and lateral head of the triceps muscle
Thoracodorsal perforator flap nerve branch
Lateral branch of intercostal nerve
What recipient vessel should not be used in breast reconstruction with an S gap flap
The axillary vessels because the pedal length is often insufficient
What is the benefit of a thoracodorsal flap over scapular and parascapular?
It is a longer pedicle and relatively thinner subcutaneous tissue
List the advantages of the medial sural artery perforator flap
Thin impliable
Less hair bearing
Long and sizable vascular pedicle
Volume can be adjusted by the inclusion of part of the gastrocnemius muscle
Plantaris tendon can be harvested at the same time
Two team approach
What is the location of the deep circumflex iliac perforator artery
One to 2 cm above the iliac crust and 5 cm behind the ASIS
What perforator flaps can be harvested as a chimeric flap
ALT
Thoracodorsal
MSAP
PAP
Describe the types of Venous flaps
Type one is unipedicled or a pure venous
Type two has an inflow and outflow vein
Type three the inflow has become arterialized and there is an outflow
What is pre-lamination
A flap is surgically altered by partial elevation, manipulation of the structure and incorporation of other tissue layers at the first stage to create a specialized composite flap
This is how nasal reconstruction is done
What is pre-fabrication
A new dominant vascular pedicle is buried in the new flap territory and six weeks later the flap is elevated and based on the new pedicle
What metabolic factors act as vasodilators
Acidosis
Hyperkalemia
Hypoxia
Hypercarpnia
Which antigens are the most immunogenic?
MHC
In humans, these are HL A’s
Class one are exposed on all nucleated cells
Class two are only expressed on antigen presenting cells like lymphocytes, monocytes, macrophages, dendritic cells, endothelial cells, and activated T cells
Describe acute rejection
Within weeks to months following a transplant
The donor APCs migrate to the host lymphoid tissue and activate T cells, which then migrate to the graft and mediate rejection
What tissue types are least antigenic
Cartilage and tendon are the least
Bone is less than skin and muscle
What immunosuppressive medication’s have not been shown to impaired wound healing
Anti-lymphocytes such as lymphocyte immune globulin, ATG and monoclonal antibodies against T cell receptors such as basaliximab
What are the important viral serology to crossmatch?
CMV
Hepatitis B
Hepatitis C
HIV
EBV
What is graft versus host disease?
This happens in bone marrow recipients
The graft views, the tissues of the recipient as foreign and the T cells attack
