Plastics/Flaps Flashcards
What is the arterial supply, nerve for the Radial forearm flap?
What M&N type?
radial artery
sensation LABC or MABC
Can be a M&N type 1 (May include BR, FCR, or PL)
But is generally a Fasciocutaneous flap (Type B FC flap)
ASIDE:
Mathes and Nahai Classification of fasciocutaneous (AKAPerforator flaps):
Type A- perforator is direct from artery to skin.
Type B- Septocutaneous perforators (ALT)
Type C- Musculocutaneous Perforators.
what can you cover with the radial forearm flap?
list sites for both as free flap and pedicled flap
Pedicled: hand, wrist, forearm, elbow
free: head/neck, UE, LE, plantar foot (sensate)
esophagus, penis
2.5mm x 20cm pedicle
What is the arterial supply and nerve supply to lateral arm flap?
M&N type?
artery: posterior br of radial collateral a
posterior cutaneous n of arm or lower lateral cutaneous nerve of arm (branch of radial n)
7.5cm x 2.5mm pedicle
M&N type B
what can you cover with the lateral arm flap?
both pedicled and free
pedicled: shoulder, axilla, elbow
free: head/neck
What is the artery and nerve supply for the medial gastroc flap?
M&N type?
M&N type 1
2mm x 6 cm
•Pedicles
–Major - Medial and Lateral sural arteries
–Minor – paired anastomotic sural vessels
•Innervation
–Tibial nerve
–Saphenous (medial), Sural (lateral)
what can you cover with medial gastroc flap?
proximal 1/3 tibia
anterior knee
distal 1/3 posterior thigh
popliteal fossa
Contralateral leg flap
What is the artery and nerve supply for the rectus femoris flap?
M&N type?
M&N type 2
artery:
- *dominant pedicle**- descending branch of lateral circumflex femoral artery (5cm, 2mm pedicle)
- *minor pedicle**- ascending branch of lateral circumflex femoral artery
- *minor pedicle** - muscular branch of superficial femoral artery
nerve:
femoral n (motor)
anterior fem cutaneous n (sensory)
what can you cover with rectus femoris flap?
inferior abdomen, groin, pubic/perineal region
This flap based on the descending branch of the lateral circumflex femoral artery provides a reliable muscle with or without skin paddle primarily for local coverage and reconstruction, at the expense of terminal thigh extension
m Coverage: inferior abdomen, groin, perineum, ischium
Reconstruction: abdominal wall
Microvascular transplantation: functional muscle for facial reanimation and upper extremity reconsruction
What is the major arterial supply and nerve supply of the gracillis flap?
M&N type?
M&N type 2
1.6mm x 6cm
Artery: Dominant: medial femoral circumflex aa (ascending branch)
Minor pedicle: Branch of SFA 2cm x 0.5mm
Motor: anterior branch of obturator nn
Sensory: medial femoral cutaneous nerve (L2-3).
•Dominant
– Ascending branch of medial circumflex femoral.
–Length – 6 cm, Diameter – 1.6 mm.
•Minor
–one or two branches of superficial femoral
–Length – 2 cm, Diameter – 0.5 mm
What are the uses of the gracillis flap?
pedicled: perineal region (vagina, anus perineum), complex pelvic injuries
free flap: extremities and head/neck
per Halifax flap manual:
Perineal, abdominal, ischial and upper/lower extremity reconstruction (free flap).
What flap can you use to cover a midshaft tibia defect?
soleus flap
M&N type 2
Popliteal AA muscle branches 1.5mm x 1cm
posterior Tibial branches 2mm x 2 cm
Peroneal AA branches 2mm x 2 cm
•Dominant
–Proximal two branches of popliteal artery (Length 0.5-1 cm, diameter 1-1.5mm)
–Proximal two branches of posterior tibial artery (Length 1-2 cm, diameter 1-2 mm) medial belly
–Proximal two branches of peroneal artery (Length 1-2 cm, diameter 1-2 mm) lateral belly
•Minor
–3-4 segmental branches of posterior tibial (L 1-1.5 cm, D 0.5 1mm)
Name & Describe the vascular classification for muscle flaps.
Mathes & Nahai
5 Types:
Type 1 - One vascular pedicle
Ex: Gastrocs flap, TFL Vastus lateralis, genioglossus Styloglossus
Type 2 - dominant pedicle and minor pedicle(s)
Ex: Gracilis, Trapezius, Soleus, rectus femoris, bicpes femoris, triceps
Type 3 - Two dominant pedicles
Ex: Glut Max, Rectus Abdominus, Pec minor, serratus, tempporais
Type 4 - Segmental vascular pedicles
Ex: Sartorius, Tib ant, Ext Oblique, EHL, FDL, FHL
Type 5 - one dominant pedicle and secondary segmental pedicles
Ex: Lat Dorsi, Pec Major, fibula, internal oblique
What is a Mathes and Nahai Type 1 Flap?
Type 1 - One vascular pedicle
–Tensor fascia Lata
–Gastrocnemius
–Vastus Lateralis
–Genioglossus
–Styloglossus
–Anconeus
–Abductor Digiti minimi
–Abductor Pollicis Brevis
What is a Mathes and Nahai Type 2 Flap?
Type 2 - dominant pedicle and minor pedicle(s)
–Gracilis
–Trapezius
–Soleus
–Rectus femoris
–Coracobrachialis
–Biceps Femoris
–Triceps
–SCM
–Platysma
–Brachioradialis
–Abductor digiti minimi (foot)
What is a Mathes and Nahai Type 3 Flap?
Type 3 - Two dominant pedicles
–Gluteus Maximus
–Rectus abdominus
–Serratus
–Pectoralis Minor
–Temporalis
–Intercostal
–Orbicularis oris
What is a Mathes and Nahai Type 4 Flap?
Segmental Pedicles
–Sartorius
–Tibialis Anterior
–External Oblique
–Extensor Hallucis Longus
–Flexor digitorum longus
–Flexor hallucis longus
What is a Mathes and Nahai Type 5 Flap?
Single Dominant and secondary segmental pedicles.
–Latissimus Dorsi
–Pectoralis Major
–Fibula
–Internal oblique
What is the reconstructive ladder?
Rung 1: Healing by secondary intention
Rung 2: Primary closure
Rung 3: Delayed primary closure
Rung 4: Split thickness graft
Rung 5: Full thickness skin graft
Rung 6: Tissue expansion
Rung 7: Random flap
Rung 8: Axial flap
Rung 9: Free flap
What is the Mathes and Nahai Classification of fasciocutaneous (AKA Perforator flaps)?
Type A- perforator is direct from artery to skin (example medial circumflex FC flap (gracilis)
Type B- Septocutaneous perforators (ALT, radial forearm)
Type C- Musculocutaneous Perforators (Paramedian forehead flap, post tib artery perforator)
