General0G14WoundCoverageTechniquesfortheInjuredExtremity幻灯片.pptVIP

* * * * * * * * * * These flaps can be raised as free flaps based on the dominant proximal vessel or as distally based rotation flaps based on the smaller pedicles entering along the course of the muscle. Examples are listed. The BR is based on a dominant perforator off the radial artery in the mid-substance of the muscle. The Gracilis is supplied by the ant. Br of the obturator artery. The soleus is supplied by a branch off the post. tibial artery. Mathes, Clinical Applications for Muscle and Musculocutaneous Flaps. Mosby 1982 * * A type III flap has two dominant vessels which allows for rotation from either end. The rectus abdominis flap is supplied by the deep inferior epigastric artery, which is the dominant vessel and will reliably supply the entire muscle. The superior epigastric artery will reliably supply the upper two-thirds of the muscle . The gluteus maximus is supplied by both the superior and inferior gluteal arteries. The inferior gluteal vessel is dominant but an excellent intramuscular vascular connection allow the gluteus to be supplied by either vessel. These vessels are separated by the piriformis muscle as they exit the pelvis. Mathes, Clinical Applications for Muscle and Musculocutaneous Flaps. Mosby 1982 * * Type IV muscles are generally not used for soft tissue reconstruction because they lack a distinct pedicle and cannot be rotated reliably on the small perforating branches. Mathes, Clinical Applications for Muscle and Musculocutaneous Flaps. Mosby 1982 * * The type V flaps have a dominant pedicle which allows them to elevated as a free flap or rotation flap. Since there is segmental blood supply to the muscle at the distal end, half the muscle can be harvested on the dominant pedicle while the remainder of the muscle is nourished from the segmental vascular pedicles. The latissimus dorsi which is the “workhorse” muscle flap for soft tissue coverage is an example of a type V muscle Mathes, Clinical Applications for Muscle and