Flaps

Question 1

Radial forearm

Answer 1

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

Question 2

Lateral arm

Answer 2

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

Question 3

ALT

Answer 3

Artery: Perforators of the descending branch of lateral circumflex femoral artery (from profunda femoris)
Vein:
Nerve: Lateral femoral cutaneous nerve

Question 4

Rectus abdominus

Answer 4

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

Question 5

Latissimus dorsi

Answer 5

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

Question 6

Gracilis

Answer 6

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

Question 7

Visceral free flaps

Answer 7

° 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

Question 8

Fibula

Answer 8

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

Question 9

Iliac crest

Answer 9

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

Question 10

Scapula

Answer 10

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

Question 11

Dorsalis pedis

Answer 11

Artery: dorsalis pedis artery
Nerve: superfi cial peroneal nerve
Thin sensate cutaneous fl ap from dorsal foot
second metatarsal included for osseocutaneous flap

Question 12

Rib

Answer 12

Intercostal vascular pedicle

Marginal blood supply to skin

Question 13

Submental

Answer 13

Submental artery

Question 14

Pectoralis

Answer 14

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

Question 15

Deltopectoral

Answer 15

fi rst–fourth intercostal perforators from the internal mammary artery
° Donor site from shoulder and chest
° Reach limited by pedicle

Question 16

Paramedian

Answer 16

Supratrochlear artery and vein

Question 17

Trapezius

Answer 17

occipital, suprascapular, transverse cervical arteries
° Can provide thin tissue suitable for pharyngeal defects
° Can be used as salvage fl ap for carotid coverage
° Little donor morbidity
° Disadvantages: vascular anatomy is variable, longer operating room time, special patient
positioning needed

Question 18

Temporoparietal

Answer 18

uperfi cial temporal artery and vein
° Thin and pliable
° Multiple applications in scalp, skull base, and midfacial reconstruction
° May be harvested for free tissue transfer
° Disadvantages: Harvest may result in alopecia at donor site.

Question 19

SCM

Answer 19

occipital artery, superior thyroid artery, branch from the thyrocervical
trunk
° Used for closure of defects in mouth, oro-, pharyngo-, and tracheocutaneous fi stulae and
at parotid bed.
° Restricted arc of rotation limits application of fl ap
° Carotid coverage may be lost if SCM is used

Question 20

Platysma

Answer 20

occipital, postauricular, facial, superior thyroid, transverse cervical arteries
° Limited role in head and neck reconstruction

Question 21

Nape of neck

Answer 21

Occipital

Question 22

Supraclavicular island flap

Answer 22

Artery: Transverse cervical->supraclavicular