Flaps Flashcards
Radial forearm
Artery: Radial artery
Vein: Venae comitantes and/or cephalic vein
Nerve: Lateral ante brachial cutaneous
Notes: Up to 10 cm and 40 % of radial circumference can be taken
Not suitable for osseointegration
Lateral arm
Artery: Terminal branch of profound brachii and posterior radial collateral artery, travels in spiral groove, septocutaneous perforators travel in lateral inter muscular septum
Vein: Venae comitantes of above vessels
Nerve: Posterior cutaneous nerve of forearm
Notes: Up to 10 cm and one-sixth of humeral circumference can be taken
ALT
Artery: Perforators of the descending branch of lateral circumflex femoral artery (from profunda femoris)
Vein:
Nerve: Lateral femoral cutaneous nerve
Rectus abdominus
Vascular: Deep (superior and inferior) epigastric arteries and veins; inferior pedicle larger and provides musculocutaneous perforators supplying the skin
Nerve: any of the intercostal nerves
Latissimus dorsi
Vascular: Thoracodorsal vessels off of subscapular vessels
Nerve: thoracodorsal nerve
Noteworthy: Can be pedicled or free. Can be combined with serratus anterior for very large defects or two paddles. Not to be used for people who depend heavily on shoulder use. Positioning is a huge pain
Gracilis
Artery: terminal branch of adductor artery (from profunda femoris)
Vein: venae comitantes, join or drain separately into profunda femoris vein
Nerve: anterior branch of obturator nerve (motor supply)
Functional muscle transfer, primary use for facial reanimation
Visceral free flaps
° Jejunum
Vascular: single vascular arcade from the superior mesenteric artery (usually second
arcade)
Peristalsis maintained by action of autonomic plexuses
° Gastro-omental
Vascular: based on right gastroepiploic artery
Fibula
Vascular: peroneal artery and vein; perforators run in posterior intermuscular
septum
Nerve: peroneal communicating branch
Bone: up to 25 cm of bone available, contourable due to segmental blood supply
Iliac crest
Artery: deep circumfl ex iliac artery off of external iliac artery; internal oblique supplied
by ascending branch of DCIA
Venous: deep circumfl ex iliac vein usually composed of two venae comitantes
Natural shape conforms to that of native mandible
Scapula
Artery: circumfl ex scapular artery off of subscapular artery, divides into transverse and
descending branches to supply two separate skin paddles (scapular and
parascapular)
Bone: separate thoracodorsal blood supply to bony component, 10–12 cm length from
inferior lateral aspect of bone
Dorsalis pedis
Artery: dorsalis pedis artery
Nerve: superfi cial peroneal nerve
Thin sensate cutaneous fl ap from dorsal foot
second metatarsal included for osseocutaneous flap
Rib
Intercostal vascular pedicle
Marginal blood supply to skin
Submental
Submental artery
Pectoralis
thoracoacromial artery, lateral thoracic (supplies inferior one-fi fth), IMA
perforators
° Donor site location easily accessible
° Donor site and pedicle generally outside of radiation fi eld
° Ease of harvest
° Pedicle not skeletonized
° Large density of arterial perforators
° Disadvantages: functional defi cit at donor site, limited reach to lateral canthus, disfi guration
in women, bulky fl ap
Deltopectoral
fi rst–fourth intercostal perforators from the internal mammary artery
° Donor site from shoulder and chest
° Reach limited by pedicle