Versatility of anterolateral thigh free flap n. rajacic md

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Versatility of anterolateral thigh free flap n. rajacic md

  1. 1. VERSATILITY OFANTEROLATERAL THIGH FREE FLAP N. Rajacic MD Al –Seef hospital Kuwait
  2. 2. mmmmmmmmmmm
  3. 3. FLAP SELECTIONRecipient site requirementsAvailabilityFamiliarity 4
  4. 4. FREE FLAPS• GROIN TEMPORALIS FASCIA• LATISSIMUS DORSI• SCAPULAR AND P.SCAPULAR FLAP SERRATUS FASCIA• RADIAL AND ULNAR FOREARM FIBULA FLAP• DELTOID FLAP• LATERAL ARM ILIAC CREST• TRAM JEJUNAL FLAP• TFL• DORSALIS PEDIS OMENTAL FLAP• … …
  5. 5. ANTEROLATERAL THIGH FLAP SONG 1984 Fu-Chan-Wei Koshima
  6. 6. VASCULAR ANATOMY DESCENDING BRANCH OF LCFASEPTOCUTANEOUS PERFORATORS (12-32%)MUSCULOCUTANEOUS PERFORATORS
  7. 7. Transverse branchNerve for m. Vastus lat. LCFA Descending branch m. Vastus. lat
  8. 8. m. Rectus femorisDescending branch LCFA Septocutaneous branch LCFA
  9. 9. Septocutaneous branchdescending branch LCFA
  10. 10. Perforating branch m. Vastus lateralis Descending branch of LCFA m. Rectus femoris
  11. 11. Musculocutaneous perforators
  12. 12. PREOPERATIVE REQUIREMENT•NO NEED OF ANGIOGRAPHY•DETECTION OF PERFORATOR BY DOPPLER FLOWMETER IS ESSENTIAL
  13. 13. Spina iliacaanterior superior PLANING OF THE FLAP Patella
  14. 14. COMPOSITIONMUSCLEMUSCLE +SKINFASCIOCUTANEOUSULTRATHIN SKINFLOW-THROUGH FLAPFUNC. MUSCLE TRANSFERVASC. NERVE GRAFT
  15. 15. MUSCLE FLAP m. Rectus femorisTFL m. Vastus lat.
  16. 16. MYOCUTANEOUS FLAP
  17. 17. FASCIOCUTANEOUS FLAP
  18. 18. PLANE OF DISSECTION
  19. 19. ULTRATHIN SKIN FLAP
  20. 20. THINING OF THE FLAP0,5 cm
  21. 21. SHAPING OF THE FLAPDEEPITHELIASATION INNER LINING OUTER COVER
  22. 22. FUNCTIONAL MUSCLE TRANSFER
  23. 23. Combined flap- chimeric principle
  24. 24. FLOW-THROUGH FLAP
  25. 25. Vascularised nerve graft
  26. 26. ADVANTAGES DISADVANTAGES• SAFE AND EASY ELEVATION • VARIABLE ANATOMY• LONG VASCULAR PEDICLE (10-12cm) • DONOR SITE GRAFTING IN CASE OF• LARGE CALIBER VESSEL (2mm) LARGE FLAPS ( MORE THAN 10 cm)• LARGE DONOR FLAP AREA (30X18cm) • HAIRY SKIN IN MALES• POSSIBILITY OF THINNING THE FLAP• MINIMAL DONOR SITE MORBIDITY• POSSIBILITY OF MULTIPLE FLAPS ON THE SAME PEDICLE (CHIMERIC PRINCIPLE)• NO NEED TO CHANGE POSITION OF THE PATINET (SUPINE POSITION)
  27. 27. CONCLUSION ANTEROLATERAL FLAP IS EXTREMELYRELIABLE FLAP FOR THE RECONSTRUCTIONS OF VARIOUS DEFECTS DUE TO GOOD LENGTH ANDSIZE OF PEDICLE, LARGE AMOUNT OF TISSUE OF DESIRABLE THICKNESS AND COMPOSITION , EASY DISSECTION AND MINIMAL DONOR SITE MORBIDITY

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