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Flaps Flashcards

0
Q

Ponten flap Classification

A

1981
Fasciocutaneous flaps
A multiple vessels at base of flap (ponten)
B single axial vessel (lower limb)
C multiple perforating vessels from intermuscular septum (RFF)
D type C with bone

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1
Q

Mathes and Nahai muscle classification

A

Type 1 Single dominant pedicle (TFL)
Type 2 Dominant and minor pedicles (Gracilis)
Type 3 Two dominant pedicles(Glut max)
Type 4 Multiple segmental pedicles (Sartorius)
Type 5 Single dominant and multiple minor pedicles which can support muscle (LD)

1981

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2
Q

Delay concept

A

Surgical interruption of part of the flap’s blood supply at a preliminary stage with intention to improve survival of the flap.

Pearl 1981:
Open choke vessels
Increase axiality of blood flow in random pattern flaps
Sympathectomy at borders -> vasodilation
Improve tolerance to ischaemia
Reduced hyperadrenergic state and vasoconstriction

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6
Q

Deltopectoral flap

A

Fasciocutaneous type C
Cutaneous axial pattern, Bakamjian 1965

Perforators from internal thoracic artery (3rd/4th IC space)

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8
Q

Pectoralis minor flap

A

Terzis 1980s

Type III

Pedicle: Pectoral branch of thoracoacromial artery from subclavian
NS: medial and lateral pectoral nerves

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9
Q

Trapezius flap

A

McCraw 1977

Type II

Pedicle: TCA (transverse cervical artery) from thyrocervical trunk.
Ascending branch to lateral flap, desc branch to vertical flap.

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10
Q

Lat Dorsi

A

Tansini 1906

Type V

Pedicle: Dominant: thoracodorsal artery off subscapular (after circumflex scapular a)
Also branches to Serratus anterior
Minor: posterior intercostals, lumbar artery perforators (LAP)

8cm length, 3mm artery

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11
Q

Serratus anterior

A

Type IV (segmental)

Upper/middle: subscapular, posterior scapular, superior thoracic
Distal: thoracic branch of thoracodorsal artery (only distal 3 of 5 slips can be used)

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12
Q

Scapular flap

A

dos Santos 1980, Nassif 1982, Hamilton 1982, Gilbert 1982

Adipocutaneous, fasciocutaneous or osteocutaneous.

Pedicle: circumflex scapular a - horizontal scapular branch and longitudinal parascapular bracnch

6cm length, 2mm artery

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13
Q

Omentum flap

A

1826? Jobet and Lambel
Kiricuta 1950s
1972 Harry Buncke and Donald McLean for scalp defect

Right omental a via gastroepiploic a., 2-3mm. 4-5cm length.
Upper laparotomy - identify greater curvature of stomach to find right & left gastroepiploic arteries. Ligate left and middle omental vessels.

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14
Q

Groin flap

A

McGregor and Jackson 1972

Fasciocutaneous flap

A: Superficial circumflex iliac artery (from femoral) = 3cm below where femoral a meets inguinal ligament
N: IC branch T12 and lat femoral cut nerve
Skin paddle - just medial to femoral v, to superolateral to vertebral column (35-40cm), 10-12cm width

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15
Q

Parascapular flap

A

Nassif 1982

Fasciocutaneous

Pedicle: circumflex scapular a (see scapular flap)

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16
Q

Gluteal flap

A

Ger 1972

Type III muscle or musculocutaneous

Dominant: superior and inferior gluteal arteries

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17
Q

Rectus abdominis

A

Robins 1979

Type III

Dominant: DIE
Minor: superior epigastric
8-10cm pedicle, 4mm artery

Pennington 1980 - TRAM
Allen 1994 - DIEP

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18
Q

Pectoralis major flap

A

Ariyan 1979
Type V
Dominant: pectoral branch of thoracoacromial (from subclavian)
Minor: lat thoracic, superior thoracic, intercostal perforators, internal thoracic perforators

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20
Q

Posterior interosseous flap

A

Penteado 1986

FC flap B

Desc branch of common interosseous division of ulnar a (10% direct from ulnar a)

1/3 from line between lateral epicondyle and DRUJ (pronated)
Enters post compartment betw supinator and APL, runs in septum betw EDM and ECU, with 7-14 perforators, anastomoses with perforating branch of ant IO at wrist

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21
Q

Deltoid flap

A

Type I

Pedicle: cutaneous branch of posterior circumflex humeral artery (from 3rd part of axillary a)

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22
Q

Temporal flaps

A
  • STF ( STA = terminal branch of ECA, bifurcates 2-4cm above zygomatic arch into frontal and parietal branches, and middle temporal a (deep branch) immed above zygomatic arch)
  • DTF (superficial to temporalis, suppl by middle temporal a, branch of STA)
  • temporalis muscle (suppl by deep temporal arteries (branches of maxillary), type 3)
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23
Q

Forehead flap

A

Sushruta Samhita 7th century

FC flap A

Supratrochlear and supraorbital arteries plus VCs

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24
Q

Converse scalping flap

A

1942

Contralateral superficial temporal arteries

Coronal incision plus skin paddle on contralateral forehead

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25
Q

Washio flap

A

1969

STA and communication with postauricular a
Raise subgaleal

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26
Q

Bilobed flap

A

Esser 1918

Local random pattern flap

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27
Q

Abbé flap and Estlander flap

A

Abbé flap - Sabattini 1838
For upper lip recon

Estlander flap for commissural defect

28
Q

Karapandzic flap and Webster flap

A

Karapandzic 1974

Lower lip defect >1/3

Webster flap = transverse cheek advancement, excise large Burrow’s triangles

29
Tongue flap
Guerrero-santios Use undersurface of tongue for lower lip, divide at 10 days. Need mouth block to prevent biting. Use anteriorly based lateral flaps for upper lip. Risk of dry mucosa.
30
Gillies fan flap, McGregor modification
Gillies 1920? 1957 - result in microstomia, similar to Estlander flap McGregor 1983 - rectangular, vertical element becomes lip border. Rotates around commissure. Nakajima flap - based on facial artery rather than labial a
31
Quaba and Maruyama flaps
Maruyama flap - incorporates dorsal MC artery and perforator as reverse flow Quaba flap - thinner, leaves dorsal MC artery behind
32
Foucher flap
Holevich 1963 "racquet flap" included branches of sup radial nerve, based over 2nd MC Then Foucher refinement (tunnelled flap) in 1979 Uses skin over dorsal index P1, based on 1st dorsal MC artery
33
Atasoy-Kleinert flap
Tranquilli-Laeli 1935, then reported by Atasoy in 1970 VY advancement of pulp
34
Kutler flap
1947 Bilateral advancement flaps for fingertips
35
Venkataswami flap
1980 Oblique advancement flap for palmar/oblique fingertips
36
Cross finger flap
Cronin 1951 Reverse cross finger flap - Atasoy
37
Hueston flap
Rotation-advancement (hatchet) flap on volar finger for fingertip recon - includes 1 NVB at base Soquet modification - used both NVBs
38
Moberg flap
1964 Volar thumb advancement Also O'Brien - rectangular flap (proximal skin divided) raised on both NVBs and advanced
39
Littler flap
Neurovascular island pedicle flap - uses ulnar border ring (or little) finger
40
TFL flap
1978 Nahai, and Hill. One of earliest described free flaps Type 1 Lat circumflex artery(lat/asc branches) (6cm below ASIS) + lat cutaneous n of thigh Now used as pedicled flap for pressure sores
41
ALT
Song 1984 (popularised by Koshima) Type C Descending branch of lat fem circumflex
42
Vastus lateralis
Type 2 Proximal 1/3: lateral circumflex femoral and transverse descending branch or "great artery" from profunda femoris Middle 1/3: perforators from profunda femoris Distal 1/3: 1st collateral of popliteal artery Usually raised on proximal vessel, to reconstruct around hip, or distal 1/3 can be distally based to cover knee
43
Lateral arm flap
Song 1982 Fasciocutaneous, osteocutaneous, fascial Posterior branch of radial collateral artery (from profunda brachii) 8cm pedicle, 2mm artery
44
Posterior thigh
FC flap Desc branch of inferior gluteal artery, skin overlying biceps femoris Can be raised with post cutaneous n of thight (in midline)
45
Saphenous artery flap
McCraw 1977 Type 2 muscle flap? Used for knee+ prox 2/3 of tibia Saphenous a (with saphenous nerve), plus perforator from post tibial a, and perforators from medial head of gastroc.
46
Gastrocnemius flap
Type 1 Medial and lateral sural arteries from popliteal Protect sural n. medial head is longer
47
Soleus flap
Type 2 Used for middle 1/3 of lower leg, can used medial hemisoleus. Post tibial and peroneal arteries
48
Medial plantar
Distal branch of post tibial - check that medial plantar artery is present! Found at proximal border of Adb hallucis, just distal to tarsal tunnel, need to divide muscle - deep branch runs adjacent to tarsal bones, superficial branch runs between Abd hallucis and FDB Sensate via medial plantar nerve
49
Reverse sural artery flap
Sural nerve and artery pierce deep fascia at mid-calf Pivot point 3 finger breadths proximal to lat malleolus. Proximal limit is where 2 heads of gastroc meet. Can also be raised antegrade.
50
DCIA flap
Mialhe 1975 and Taylor 1979 Can take iliac crest (not ASIS) and internal oblique (if ascending branch preserved, 1cm superior to ASIS) A: DCIA arises from ext iliac at level of inguinal ligament, courses within fascial sheath behind inguinal lig 8cm pedicle, 4mm artery
51
Fibular flap
Taylor 1975 A: nutrient artery of fibula, from peroneal, from posterior tibio-peroneal trunk. Minor pedicle from peroneal artery (medial and post aspect of fibula) 6cm pedicle, 3mm artery
52
Dorsalis pedis
McCraw 1975 Axial FC flap +\- tendon, bone, sensation(deep and superficial peroneal nerves) Entire dorsum of foot, 1st web space, and medial 3 toes and MTs
53
Bilobed flap
Esser 1918 2 transposition flap, tertiary defect must loe in line with RSTLs
54
SGAP
Allen 1995 Type 3 A: sup gluteal 8cm pedicle, 3mm artery
55
EDB flap
Muscle flap, no skin paddle Lateral tarsal artery, with branch from DP. Can trace back to origin from ant tibial a Origin - ant surface of calcaneus and inferior ext retinaculum, insertion onto P1s and long toe extensors
56
Posterior interosseous flap
Penteado 1986 PIA- descending branch of common interosseous division of ulnar artery (or from ulnar a in 10%) For 1st web space, thumb, dorsal hand to PIPJ level, palm and wrist coverage
57
Becker flap
Becker 1988/1992 Used as propellor flap - pivot point 2cm proximal to pisiform Ulnodorsal artery from ulnar artery - middle branch supplies skin via ascending and descending branches
58
Radial forearm flap
Yang 1981, Song 1982 Type C Proximal branch near origin Middle branch 7-8cm proximal to radial styloid. Distal branch 2cm proximal to styloid (runs beneath PQ for osseous component) Perforators lie within septum betw BR and FCR 15cm pedicle, 3mm artery
77
Gracilis muscle/musculocutaneous flap
Harii 1976/8 Pickrell 1956 Type 2 Pedicle - branch off med fem circumflex (smaller A1 from profunda femoris, A3 from superficial femoral a), VC x2 into profunda femoral v Nerve - single motor - ant branch of obturator n 8cm pedicle, 3mm artery

FRCS Plast (2 decks)

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