Gracilis and Latissimus Dorsi flap
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The gracilis muscle is a thin muscle in the thigh that can be used as a free flap for reconstruction. It is 25-30 cm in length with a 10-12 cm tendon. The muscle is innervated by the obturator nerve and receives its blood supply from the gracilis vessels of the medial femoral circumflex artery system. It is commonly used in head and neck reconstruction or to repair soft tissue defects. The latissimus dorsi muscle is one of the largest muscles in the body and can be harvested as a pedicled or free flap, often with a skin paddle. It is innervated by the thoracodorsal nerve and receives its blood supply from the thoracod
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Plastic and reconstructive surgery presentation.pptx
Plastic and reconstructive surgery presentation.pptx
More from Dr Sourabh Shankar Chakraborty
Eyelid reconstruction
The document discusses eyelid reconstruction, including:
1. It describes the anatomy of the eyelid, including the palpebral fissure size, positions of the canthi and eyelid margins, and layers of the eyelid.
2. Common reasons for eyelid reconstruction include congenital anomalies, tumors, and trauma. Principles of reconstruction include thorough evaluation, debridement of nonviable tissue, and aligning all tissue layers.
3. Various flap techniques are described for reconstructing different areas of the eyelid, including tarsoconjunctival flaps, cheek flaps, forehead flaps, and V-Y flaps. Complications of reconstruction include issues like corneal abrasion
Vascular anomalies
This document discusses vascular anomalies including infantile hemangioma and various types of vascular malformations such as capillary, venous, arteriovenous, and lymphatic malformations. It covers the classification, clinical features, investigations, management, and complications of these conditions. Key points include that infantile hemangiomas have a distinct growth cycle of proliferation, involution, and involuted phases while vascular malformations are present at birth and grow proportionally with the child. Management involves observation, medications like corticosteroids and propranolol, laser therapy, surgery, and embolization depending on the specific anomaly and risk of complications.
Tissue expansion- principles and techniques
Tissue expansion is a surgical technique used to generate additional skin and soft tissue for reconstructive purposes. It involves inserting a temporary implant called a tissue expander under the skin and gradually inflating it with saline over 6-12 weeks to stretch the overlying tissue. This causes mechanical and biological tissue growth. The expander is then removed and the expanded skin is advanced to reconstruct areas of skin loss or defects. Complications can include hematoma, seroma, expander deflation or migration, and skin thinning or necrosis but tissue expansion provides a good source of autologous tissue for reconstruction when other options are limited.
Principles of tendon transfer
Tendon transfers involve rerouting a functioning muscle tendon unit to restore lost function according to established principles. The key principles are having supple joints at the donor and recipient sites, maintaining soft tissue equilibrium, ensuring the donor has adequate excursion and strength, choosing an expendable donor, maintaining a straight line of pull, selecting donors and recipients with synergistic functions, and performing single tendon transfers for single functions. Tendon transfers can restore grasp, pinch and upper extremity motions according to these principles.
Tenosynovitis
This document discusses tenosynovitis, including its definition, etiology, prognosis, pathophysiology, history, physical examination findings, workup, treatment, and postoperative care. Tenosynovitis is inflammation of the tendon sheath that can be caused by overuse, infection, or inflammatory conditions like rheumatoid arthritis. Physical exam may reveal tenderness, swelling, or limited range of motion. Treatment depends on the cause but may include rest, splinting, anti-inflammatories, corticosteroid injections, or surgery. Prognosis is generally good if treated early without comorbidities, while complications can include adhesion formation or tendon rupture if left untreated.
Tendon transfer- principles and techniques
1. Tendon transfers involve rerouting a functioning muscle tendon unit to restore a function lost due to nerve injury or other conditions. Common indications include nerve injuries or trauma.
2. Key principles of tendon transfer include having supple joints, adequate excursion of the donor muscle, and maintaining a straight line of pull. Common procedures restore functions like finger extension, thumb opposition, and wrist extension.
3. Rehabilitation after tendon transfer focuses on immobilization followed by gentle range of motion and strengthening exercises over 8-12 weeks before returning to full activity.
Temporomandibular joint
- The temporomandibular joint (TMJ) is located between the condylar process of the mandible and the mandibular fossa and articular eminence of the temporal bone. It is a bi-arthroidal hinge joint containing synovial fluid that allows for translational and rotational movements.
- Temporomandibular disorders (TMD) is a collective term used for clinical problems involving the masticatory muscles, TMJ, and associated structures. Common signs and symptoms include pain and limited opening of the mouth.
- Disc displacement is the most common TMJ articular disorder and can involve reduction or lack of reduction of the articular disc. Conservative treatments include
Suture techniques, Z-plasty
The document describes various suture techniques including simple interrupted sutures, which are the gold standard, subcuticular sutures which avoid external knots, half-buried horizontal mattress sutures which keep knots on one side, continuous over-and-over sutures which can be placed rapidly but are less precise than interrupted sutures, skin staples which are a timesaving alternative to sutures, skin tapes and adhesives which can be used in low tension areas, and Z-plasties which help prevent or limit scarring and contractures. It also outlines indications, contraindications and potential complications of Z-plasty techniques.
Replantation of the hand and Upper extremity
1. Replantation involves reattaching a completely amputated body part to restore blood flow, while revascularization reattaches incompletely amputated parts.
2. Factors that determine replantation success include patient health, injury details, and surgical team skill.
3. The operative technique prioritizes veins, arteries, bones, tendons, and nerves with the goal of minimizing warm ischemia time.
Skin donation, skin banking, skin culture
1. Skin banking involves procuring skin from donors after death, processing it which may include cryopreservation or lyophilization, and storing it to be used for burn patients or other wounds.
2. The first skin bank was established in 1971 and they continue to improve techniques like reducing immunogenicity and potential for disease transmission.
3. Skin culture techniques also allow creating skin substitutes using fibroblasts, keratinocytes and endothelial cells grown on collagen gels or cadaver dermis in organotypic culture.
Nerves of hand
The document summarizes the anatomy and branches of the ulnar, radial, and median nerves in the upper limb. It describes the course and branches of each nerve in the axilla, arm, and forearm. It also discusses the separation of motor and sensory components within the nerves and provides diagrams of fascicular patterns. Key points include that the ulnar nerve supplies medial forearm muscles and skin of the little and half of the ring finger, the radial nerve innervates posterior forearm muscles and skin of the dorsal hand, and the median nerve gives branches in the forearm and palm.
Neck lift, forehead and thread lift
This document discusses various surgical approaches for forehead and brow lifting as well as neck lifting. For forehead lifts, it describes techniques like the coronal approach and its disadvantages like scalp numbness. It also covers other approaches like the temple approach and endoscopic approach. For neck lifts, it discusses factors to consider like skin elasticity and platysma muscle treatment. It provides details on the surgical process for different grades of neck laxity and describes techniques like subcutaneous lipectomy and platysma plication. Post-operative care is also outlined for both forehead and neck procedures.
Mandibular fracture- diagnosis
This document discusses the classification, diagnosis, and treatment of mandibular fractures. Key points include:
- Mandibular fractures are classified based on location and examined clinically and radiographically.
- Treatment options include closed or open reduction, with closed reduction used for minimally displaced fractures and open reduction for more complex cases.
- Internal fixation methods like miniplates are used to achieve rigid stabilization during open reduction, while intermaxillary fixation can be used short-term for closed reduction.
- Potential complications include hemorrhage, infection, nonunion, and neurosensory changes. Proper treatment aims to restore occlusion and minimize complications.
Skin healing and repair
This document discusses the stages of skin graft take, including plasmatic imbibition, inosculation and capillary ingrowth, and revascularization. It describes graft fixation, contraction, reinnervation, pigmentation, and factors that can lead to graft failure. The stages of graft take typically involve serum imbibition for 24-48 hours, development of fine vasculature in a fibrin layer, and eventual blood flow as the graft becomes pink. Revascularization may occur through direct vessel anastomoses, new vascular channel formation, or a combination. Proper fixation and aftercare are important for successful graft take.
Liposuction- techniques and indications
Liposuction is a surgical procedure to remove unwanted fat deposits from beneath the skin. It was originally introduced in the 1980s and involves using suction to aspirate fat through small incisions. There are several techniques including traditional suction-assisted liposuction, ultrasound-assisted, power-assisted, vaser-assisted, and laser-assisted liposuction. Patient selection, pre-operative evaluation and planning, anesthesia technique, and post-operative care are important considerations to achieve optimal results and avoid complications from liposuction.
Local flaps classifications
This document describes different types of local flaps that can be used in skin grafting and reconstructive procedures. It outlines pivotal flaps, advancement flaps, and hinge flaps. Pivotal flaps involve rotation, transposition, or interpolation of skin and come in various shapes. Advancement flaps can be unipedicled, bipedicled, or in a V-Y or Y-V configuration. They take advantage of skin elasticity or use Burrow triangles to advance the skin. Pantographic expansion is another advancement technique but carries more risk.
Flexor tendon repair
Flexor tendon repair requires protecting the tendon repair while allowing early controlled motion to minimize adhesions. This involves splinting the fingers in flexion after primary repair or tendon grafting, followed by progressive range of motion exercises. Complications can include infection, scarring and joint contractures, but good outcomes are achieved with protocols emphasizing early motion like Duran or Kleinert methods.
Gastrocnemius and Forehead flap
This document describes two types of flaps: the gastrocnemius flap and the forehead flap. The gastrocnemius flap uses the medial or lateral head of the gastrocnemius muscle and surrounding tissue to cover defects of the proximal or anterior leg. The forehead flap uses skin and tissue from the forehead, supplied by the supratrochlear artery, to reconstruct nasal or periorbital defects. Key details about the vascular anatomy, dimensions, and applications of each flap are provided.
Electric burn injury- diagnosis and management
Electrical injuries can cause damage through direct tissue damage, thermal energy, and mechanical injury. They result in around 1000 deaths and 3000 burns center admissions per year in the US. The main mechanisms of injury are electrical energy altering cell membranes, massive tissue destruction from heat, and physical trauma. Management involves following ATLS protocols, monitoring for cardiac issues, treating potential myoglobinuria, aggressive wound care, and surgery as needed. Prevention focuses on electrical safety practices and seeking shelter during storms.
Microtia- diagnosis and management
Microtia is a congenital deformity where the external ear is underdeveloped, ranging from small ears to complete absence of the auricular tissues. Treatment options include autologous costal cartilage grafts and prosthetic reconstruction. The Tanzer, Brent, and Nagata techniques use harvested rib cartilage to construct an ear framework, with differences in staging and sculpting of features. Complications can include chest wall deformities, skin necrosis, infection, and resorption of the cartilage graft over time.
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Gracilis and Latissimus Dorsi flap
- 2. • Microvascular Free Gracilis Muscle • Musculocutaneous Flap
- 3. • Muscle is 25 to 30 cm in length, with an additional 10 to 12 cm of tendon • Origin: body of pubis and its inferior ramus and adjacent ramus of the ischium • Between the adductor longus and the adductor magnus • Insertion: just below tibial tubercle between sartorius and semitendinosis
- 6. • Innervation: Branch from the obturator nerve to gracilis (12 cm) • Pedicle length:up to 6 cm. • Blood supply: Gracilis vessels from the medial femoral circumflex system. • Artery:Usually small caliber, from 1 to 2 mm. • Veins:Two venae, one usually slightly larger than the artery. • Skin paddle up to 20 cm X 10 cm
- 9. Indications • In head and neck reconstruction for dynamic reanimation of the midface and for the eye and forehead • Reconstruction of total or near-total glossectomy defect • Repair of full-thickness scalp defects • Soft tissue filling for surgical defects (eg, orbital exenteration) • Replacement of major muscular defects with functional loss (FFMT)
- 10. Advantages • muscle is easy to remove, • can be reliably transferred on its pedicle, • produces no functional loss, • leaves an incisional scar on the upper medial portion of the thigh, where it is easily hidden • transferred as free functional muscle
- 13. • Pedicle is 8 to 12 cm from the muscle origin and will pass under the adductor longus muscle • Skin paddle is not reliable distal to 15 cm from the muscle origin • For FFMT determining muscle tension by abducting thigh and extending knee.
- 17. • Free LD flap • Pedicled LD flap • Myocutaneous flap • Split latissimus dorsi muscle flap • Osteomyocutaneous flap
- 19. • Origin: on the iliac crest inferiorly and the thoracolumbar fascia posteriorly near the midline, spinous processes • thoracodorsal nerve (C6,7,8) • thoracodorsal artery • Artery:Can be up to 2 or 5 mm if harvested up to the subscapular artery • Pedicle length: Up to 15 cm • perforators from thoracic intercostal and lumbar arteries
- 21. • largest muscle in the body, up to 20 X 40 cms • combined with the serratus, scapular or parascapular flaps • quite thin (less than 1 centimeter thick) • re-innervated (thoracodorsal nerve) flap can be used as a functional muscle.