Muscle Flaps.ppt

Muscle Flaps Trefor Nodwell MD CM Dr. D. Lalonde, FRCSC Dr. W. Parkhill, FRCSC Outline Review Basic Anatomical and Physiologic Review Reconstructive Goals Principles Classification Schemes with examples Muscle Flaps Only Common Examples Type/Pattern of Circulation Applications Anatomy and Elevation Outline Precautions/Pitfalls Brief overview of Less Common (but applicable) flaps Discussion The Basics - Anatomy Motor nerves are always accompanied by vascular pedicles Pedicles Dominant – can sustain entire muscle on its own Minor – maintains only a portion of the muscle Segmental –nourishes small segment of the muscle Allows for a classification scheme The Basics- Physiology Arc of Rotation Standard – extent of reach of the muscle based on its dominant pedicle Reverse (distally based) – restricted by secondary pedicles The Basics- Physiology Choke arteries Small caliber vessels allowing bidirectional flow Oscillating veins No valves, allows reversal of flow Perforators Vessels pass through muscle to supply overlying skin Identified preoperatively The Basics Balance reconstructive needs and sacrifice of normal function Reconstructive Ladder versus Triangle Defect analysis Location Size Physical Components Environment –host factors The basics – Goals Principles Safety - successful wound coverage Identify and protect pedicle Conservative skin territories Tension- at pedicle or inset site Form- normal shape or contour Restoration at defect Preservation at donor site The basics – Goals Principles Function – stability of closure, specialized functions. Hair growth Sensibility Skeletal Support Locomotion (or animation) Classification Classification According to mode of innervation (Taylor) Type I – single unbranched nerve enters muscle. Type II- Single nerve, branches prior to entering. Type III – Multiple branches from same nerve trunk. Type IV – Multiple branches from different nerve trunks. Affects suitability for functioning muscle transfer Classification Vascul