The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and offering a wide range of dental certified courses in different formats.
Indian dental academy provides dental crown & Bridge,rotary endodontics,fixed orthodontics,
Dental implants courses.for details pls visit www.indiandentalacademy.com ,or call
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The document discusses various types of local flaps used in head and neck reconstruction. Local flaps involve moving tissue from one site to another to repair defects. There are several types of local flaps classified based on how the tissue moves (advancement, pivotal, interpolation) and what tissues are included (skin, muscle, fat). Common examples used to repair facial defects include buccal fat pad flaps, tongue flaps, and various types of advancement and pivotal flaps. Proper planning and design of local flaps is necessary to close wounds and defects with adequate tissue while avoiding dog ears or tension.
The temporoparietal fascial flap (TPF) uses fascia from the scalp which is supplied by the superficial temporal artery. It can be used as a pedicled or free flap for reconstruction of facial, orbital, and skull defects. The relevant anatomy is described including landmarks for incision and dissection. Indications include reconstruction of oral, orbital, and cranial defects. Advantages are an easy harvest with a reliable vascular pedicle and low donor site morbidity. Disadvantages include a short pedicle length and potential scarring or alopecia at the donor site.
The document summarizes the anterolateral thigh (ALT) flap, which has become a popular reconstructive option. It describes the history and indications of the ALT flap, including head and neck and extremity reconstruction. The key aspects of evaluating patients, raising the flap, and post-operative care and complications are covered. The advantages include a long vascular pedicle and ability to harvest a large skin paddle, while disadvantages include a bulky flap and potential donor site morbidity. Variations in anatomy are also discussed.
The pectoralis major flap uses the pectoralis major muscle and overlying skin to reconstruct head and neck defects. It has a reliable blood supply from the thoracoacromial artery. The muscle is raised from the chest wall and tunneled to the defect site. The skin paddle size and position can be adjusted depending on the location and size of the defect. Complications are rare but include infection, partial flap necrosis, and donor site issues. It provides a bulky well-vascularized tissue for reconstruction with minimal morbidity.
The latissimus dorsi free flap is a muscle flap that can be harvested with a skin paddle. It has a long vascular pedicle from the thoracodorsal artery and vein, allowing it to reach distant sites. The large size of the latissimus dorsi muscle makes it suitable for covering large wounds. It is one of the most commonly used flaps in reconstructive microsurgery, along with the rectus abdominis and radial forearm flaps. While harvesting the flap requires the patient to be in a side-lying position, it provides ample tissue to reconstruct large defects of the head, neck, and other areas.
This document discusses various flap techniques used in ENT reconstruction. It begins with a brief history of flaps and then covers principles of mucosal, skin, bony, lip, nasal, and pinna reconstruction. Different types of flaps are described such as local advancement flaps, rotational flaps, transposition flaps, interpolated flaps, myocutaneous flaps, and examples such as forehead, nasolabial, pectoralis major, deltopectoral, and temporoparietal flaps. Design, vascular supply, and advantages of local flaps are also summarized.
This study presents the posteromedial thigh flap as an alternative donor site for head and neck reconstruction. 23 patients underwent reconstruction of various head and neck defects using the posteromedial thigh flap. Three types of perforator patterns were identified, with the majority originating from the profunda femoris artery. The average pedicle length was 10.3 cm. Two flap designs - transverse and vertical - were used depending on defect size. The flap success rate was 95.6% with minimal complications. The posteromedial thigh flap provides reliable tissue for head and neck reconstruction with a concealed donor site scar and ability for primary closure.
The document discusses various types of local flaps used in head and neck reconstruction. Local flaps involve moving tissue from one site to another to repair defects. There are several types of local flaps classified based on how the tissue moves (advancement, pivotal, interpolation) and what tissues are included (skin, muscle, fat). Common examples used to repair facial defects include buccal fat pad flaps, tongue flaps, and various types of advancement and pivotal flaps. Proper planning and design of local flaps is necessary to close wounds and defects with adequate tissue while avoiding dog ears or tension.
The temporoparietal fascial flap (TPF) uses fascia from the scalp which is supplied by the superficial temporal artery. It can be used as a pedicled or free flap for reconstruction of facial, orbital, and skull defects. The relevant anatomy is described including landmarks for incision and dissection. Indications include reconstruction of oral, orbital, and cranial defects. Advantages are an easy harvest with a reliable vascular pedicle and low donor site morbidity. Disadvantages include a short pedicle length and potential scarring or alopecia at the donor site.
The document summarizes the anterolateral thigh (ALT) flap, which has become a popular reconstructive option. It describes the history and indications of the ALT flap, including head and neck and extremity reconstruction. The key aspects of evaluating patients, raising the flap, and post-operative care and complications are covered. The advantages include a long vascular pedicle and ability to harvest a large skin paddle, while disadvantages include a bulky flap and potential donor site morbidity. Variations in anatomy are also discussed.
The pectoralis major flap uses the pectoralis major muscle and overlying skin to reconstruct head and neck defects. It has a reliable blood supply from the thoracoacromial artery. The muscle is raised from the chest wall and tunneled to the defect site. The skin paddle size and position can be adjusted depending on the location and size of the defect. Complications are rare but include infection, partial flap necrosis, and donor site issues. It provides a bulky well-vascularized tissue for reconstruction with minimal morbidity.
The latissimus dorsi free flap is a muscle flap that can be harvested with a skin paddle. It has a long vascular pedicle from the thoracodorsal artery and vein, allowing it to reach distant sites. The large size of the latissimus dorsi muscle makes it suitable for covering large wounds. It is one of the most commonly used flaps in reconstructive microsurgery, along with the rectus abdominis and radial forearm flaps. While harvesting the flap requires the patient to be in a side-lying position, it provides ample tissue to reconstruct large defects of the head, neck, and other areas.
This document discusses various flap techniques used in ENT reconstruction. It begins with a brief history of flaps and then covers principles of mucosal, skin, bony, lip, nasal, and pinna reconstruction. Different types of flaps are described such as local advancement flaps, rotational flaps, transposition flaps, interpolated flaps, myocutaneous flaps, and examples such as forehead, nasolabial, pectoralis major, deltopectoral, and temporoparietal flaps. Design, vascular supply, and advantages of local flaps are also summarized.
This study presents the posteromedial thigh flap as an alternative donor site for head and neck reconstruction. 23 patients underwent reconstruction of various head and neck defects using the posteromedial thigh flap. Three types of perforator patterns were identified, with the majority originating from the profunda femoris artery. The average pedicle length was 10.3 cm. Two flap designs - transverse and vertical - were used depending on defect size. The flap success rate was 95.6% with minimal complications. The posteromedial thigh flap provides reliable tissue for head and neck reconstruction with a concealed donor site scar and ability for primary closure.
Free LD flap for scalp reconstruction DR VIPIN V NAIRPGIMER Chandigarh
The document discusses using a free latissimus dorsi (LD) flap to reconstruct a large scalp defect with intact skull bone. It provides details on the anatomy and vascular supply of the LD flap, indications for its use, surgical technique for harvest and transfer, and post-operative care considerations to ensure flap survival. The LD flap provides a large surface area for reconstruction with minimal donor site morbidity. Proper patient positioning, monitoring for signs of vascular compromise, and measures to promote flap perfusion are important to achieve successful reconstruction.
This document discusses anatomy and reconstruction techniques for the heel. It describes the layers of the sole, including muscles, tendons, and nerves. The medial and lateral plantar nerves and arteries are examined in detail. Reconstruction options for the anterior and posterior heel are provided, such as local flaps, skin grafting, and free flaps. The medial plantar and sural flaps are highlighted as examples. In summary, this document reviews the anatomy of the foot sole and discusses approaches for reconstructing soft tissue injuries of the heel region.
1. The gastrocnemius muscle consists of medial and lateral heads that are supplied by the medial and lateral sural arteries respectively.
2. The medial gastrocnemius flap is most commonly used due to its large size and reliable vascular pedicle. It can be raised as a muscle or musculocutaneous flap to cover defects of the upper leg and knee.
3. The lateral gastrocnemius flap is smaller but can be used for smaller defects of the upper lateral leg and knee. Both flaps have consistent anatomy and can be reliably elevated based on the dominant sural artery pedicles.
Microsurgery involves surgery performed under magnification using specialized small instruments. It requires precise hand movements and suturing of small tissues and blood vessels. Proper equipment, techniques, and magnification are essential for achieving successful microsurgical reconstructions. The document outlines the principles, history, equipment, positioning, and technical aspects of microsurgery.
It is just a concise presentation about anatomy of larynx & TB tree. little bit about anaesthetic consideration regarding vocalcordpalsy and aspiration pneumonitis.
The document describes several surgical approaches to the humerus. The anterior approach exposes the anterior surface of the humeral shaft and is used for fracture fixation and tumor resection. The anterolateral approach exposes the distal fourth of the humerus and is used for distal fracture fixation and radial nerve exploration. The posterior approach provides access to the lower three-fourths of the posterior humerus and is used for fracture fixation and nerve/tumor procedures. The lateral approach exposes the lateral epicondyle and is used for lateral condyle fractures and tennis elbow treatment. All approaches require identification and protection of vulnerable nerves like the radial and axillary.
The larynx contains several cartilages that provide structure, including the thyroid, cricoid, epiglottis, and arytenoid cartilages. It is located in the neck and extends from the base of the tongue to the trachea. The larynx contains intrinsic ligaments like the vocal ligaments and extrinsic muscles that attach it to surrounding structures like the hyoid bone. It plays important roles in voice production, airway protection, and breathing.
Local and regional flaps in head and neck reconstructionSaleh Bakry
Local and regional flaps are used for head and neck reconstruction. There are several types of flaps classified by blood supply, location, configuration, tissue content, and transfer method. Local flaps use adjacent tissue while regional flaps are near but not adjacent. Free flaps completely detach tissue and reconnect blood vessels microsurgically. Examples of local and regional flaps discussed are advancement, rotation, and transposition flaps as well as pedicled and free myocutaneous flaps.
This document describes the scapular flap procedure. It details the relevant surgical landmarks and arterial system around the scapula. The flap can include skin, muscle, and bone from the scapula region. The flap is designed and harvested by following the path of the circumflex scapular artery. For a bone flap, the periosteal branch is dissected to access bone from the lateral border of the scapula. The scapular flap provides a large volume of soft tissue and bone to reconstruct significant defects, such as after extensive maxillectomies or mandibular resections.
This document describes the arterial blood supply and potential flaps in the lower limb. It discusses various fasciocutaneous and musculocutaneous flaps that can be raised based on named arteries in the lower limb, including the femoral, lateral circumflex femoral, profunda femoris, popliteal, and posterior tibial arteries. Specific flaps are described such as the anteromedial thigh flap, gracilis flap, and gastrocnemius flap. The angiosome concept and variations in vascular anatomy are also covered.
Dr. Gavinash Rao presented on the history and techniques of perforator flaps. Key points include:
- Perforator flaps rely on perforating vessels that pass through deep fascia to supply skin and soft tissue. They were first described in 1989 and gained popularity after conferences in 2001 and 2005.
- Advantages over traditional flaps include reduced donor site morbidity and more tailored reconstruction to match defects. Various types of perforator flaps have been developed like propeller flaps.
- Angiosomes describe the vascular territories of perforators and helped develop special flap designs. Perforasomes further describe the territory of individual perforators.
- Techniques include identifying perforators with
The larynx houses the vocal cords and protects the entrance to the lower respiratory tract. It develops from the foregut in the 4th week of gestation. The larynx is made up of cartilage, including the thyroid, cricoid, and arytenoid cartilages. It attaches to the hyoid bone and contains intrinsic muscles. The larynx has supraglottic, glottic, and subglottic regions and differs in infants due to smaller size and shape. The document provides details on the anatomy, development, features and surgical considerations of the larynx.
The document describes the anatomy of the larynx. It discusses the cartilages that make up the larynx, including the thyroid, cricoid, arytenoid, epiglottis, corniculate and cuneiform cartilages. It describes the ligaments that connect the cartilages, including the thyrohyoid membrane, cricothyroid membrane, quadrangular membrane, thyroepiglottic ligament and conus elasticus. The larynx contains the vocal folds and is involved in sound production and airway protection during breathing and swallowing.
This document provides an overview of laryngeal anatomy, pathology, investigations, and staging of laryngeal cancers. It describes the cartilages, ligaments, muscles, blood supply, innervation, and histology of the larynx. Common sites of laryngeal cancer are discussed along with patterns of spread. Investigations for laryngeal cancer including laryngoscopy, CT, MRI, and direct laryngoscopy are summarized. Staging of laryngeal cancers is also reviewed briefly.
The document discusses the anterolateral thigh (ALT) flap, which was first introduced in 1984 for reconstruction. It has since become popular for head and neck reconstructions. The ALT flap has reliable anatomy based on the descending branch of the lateral circumflex femoral artery. It provides a long vascular pedicle and large skin paddle. While it has some disadvantages like a bulky flap, the ALT flap allows minimal donor site morbidity and rapid post-operative recovery.
The document describes the cartilages that make up the larynx. It details the location, shape, attachments and functions of the thyroid, cricoid, epiglottis, arytenoid, corniculate and cuneiform cartilages. The thyroid cartilage is the largest and forms an angle that is more acute in males, giving them a more prominent laryngeal prominence called the Adam's apple. The cricoid forms a ring below the thyroid. Together these cartilages provide structure and attachments for the muscles controlling the larynx.
The document discusses the surgical anatomy of the masseter muscle and facial nerve. It notes the relationships of the masseter muscle anteriorly, posteriorly, laterally, and medially. It then describes the surgical approach for locating the facial nerve, which involves making an incision in front of the ear tragus and dissecting through tissue to identify the styloid process as the first landmark. Finally, it provides measurements for distances between branches of the facial nerve and bony landmarks to help surgeons locate the nerve during procedures.
Properties of Denture base materials /rotary endodontic coursesIndian dental academy
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.for more details please visit
www.indiandentalacademy.com
Diagnosis and treatment planning in completely endntulous arches/dental coursesIndian dental academy
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.for more details please visit
www.indiandentalacademy.com
Free LD flap for scalp reconstruction DR VIPIN V NAIRPGIMER Chandigarh
The document discusses using a free latissimus dorsi (LD) flap to reconstruct a large scalp defect with intact skull bone. It provides details on the anatomy and vascular supply of the LD flap, indications for its use, surgical technique for harvest and transfer, and post-operative care considerations to ensure flap survival. The LD flap provides a large surface area for reconstruction with minimal donor site morbidity. Proper patient positioning, monitoring for signs of vascular compromise, and measures to promote flap perfusion are important to achieve successful reconstruction.
This document discusses anatomy and reconstruction techniques for the heel. It describes the layers of the sole, including muscles, tendons, and nerves. The medial and lateral plantar nerves and arteries are examined in detail. Reconstruction options for the anterior and posterior heel are provided, such as local flaps, skin grafting, and free flaps. The medial plantar and sural flaps are highlighted as examples. In summary, this document reviews the anatomy of the foot sole and discusses approaches for reconstructing soft tissue injuries of the heel region.
1. The gastrocnemius muscle consists of medial and lateral heads that are supplied by the medial and lateral sural arteries respectively.
2. The medial gastrocnemius flap is most commonly used due to its large size and reliable vascular pedicle. It can be raised as a muscle or musculocutaneous flap to cover defects of the upper leg and knee.
3. The lateral gastrocnemius flap is smaller but can be used for smaller defects of the upper lateral leg and knee. Both flaps have consistent anatomy and can be reliably elevated based on the dominant sural artery pedicles.
Microsurgery involves surgery performed under magnification using specialized small instruments. It requires precise hand movements and suturing of small tissues and blood vessels. Proper equipment, techniques, and magnification are essential for achieving successful microsurgical reconstructions. The document outlines the principles, history, equipment, positioning, and technical aspects of microsurgery.
It is just a concise presentation about anatomy of larynx & TB tree. little bit about anaesthetic consideration regarding vocalcordpalsy and aspiration pneumonitis.
The document describes several surgical approaches to the humerus. The anterior approach exposes the anterior surface of the humeral shaft and is used for fracture fixation and tumor resection. The anterolateral approach exposes the distal fourth of the humerus and is used for distal fracture fixation and radial nerve exploration. The posterior approach provides access to the lower three-fourths of the posterior humerus and is used for fracture fixation and nerve/tumor procedures. The lateral approach exposes the lateral epicondyle and is used for lateral condyle fractures and tennis elbow treatment. All approaches require identification and protection of vulnerable nerves like the radial and axillary.
The larynx contains several cartilages that provide structure, including the thyroid, cricoid, epiglottis, and arytenoid cartilages. It is located in the neck and extends from the base of the tongue to the trachea. The larynx contains intrinsic ligaments like the vocal ligaments and extrinsic muscles that attach it to surrounding structures like the hyoid bone. It plays important roles in voice production, airway protection, and breathing.
Local and regional flaps in head and neck reconstructionSaleh Bakry
Local and regional flaps are used for head and neck reconstruction. There are several types of flaps classified by blood supply, location, configuration, tissue content, and transfer method. Local flaps use adjacent tissue while regional flaps are near but not adjacent. Free flaps completely detach tissue and reconnect blood vessels microsurgically. Examples of local and regional flaps discussed are advancement, rotation, and transposition flaps as well as pedicled and free myocutaneous flaps.
This document describes the scapular flap procedure. It details the relevant surgical landmarks and arterial system around the scapula. The flap can include skin, muscle, and bone from the scapula region. The flap is designed and harvested by following the path of the circumflex scapular artery. For a bone flap, the periosteal branch is dissected to access bone from the lateral border of the scapula. The scapular flap provides a large volume of soft tissue and bone to reconstruct significant defects, such as after extensive maxillectomies or mandibular resections.
This document describes the arterial blood supply and potential flaps in the lower limb. It discusses various fasciocutaneous and musculocutaneous flaps that can be raised based on named arteries in the lower limb, including the femoral, lateral circumflex femoral, profunda femoris, popliteal, and posterior tibial arteries. Specific flaps are described such as the anteromedial thigh flap, gracilis flap, and gastrocnemius flap. The angiosome concept and variations in vascular anatomy are also covered.
Dr. Gavinash Rao presented on the history and techniques of perforator flaps. Key points include:
- Perforator flaps rely on perforating vessels that pass through deep fascia to supply skin and soft tissue. They were first described in 1989 and gained popularity after conferences in 2001 and 2005.
- Advantages over traditional flaps include reduced donor site morbidity and more tailored reconstruction to match defects. Various types of perforator flaps have been developed like propeller flaps.
- Angiosomes describe the vascular territories of perforators and helped develop special flap designs. Perforasomes further describe the territory of individual perforators.
- Techniques include identifying perforators with
The larynx houses the vocal cords and protects the entrance to the lower respiratory tract. It develops from the foregut in the 4th week of gestation. The larynx is made up of cartilage, including the thyroid, cricoid, and arytenoid cartilages. It attaches to the hyoid bone and contains intrinsic muscles. The larynx has supraglottic, glottic, and subglottic regions and differs in infants due to smaller size and shape. The document provides details on the anatomy, development, features and surgical considerations of the larynx.
The document describes the anatomy of the larynx. It discusses the cartilages that make up the larynx, including the thyroid, cricoid, arytenoid, epiglottis, corniculate and cuneiform cartilages. It describes the ligaments that connect the cartilages, including the thyrohyoid membrane, cricothyroid membrane, quadrangular membrane, thyroepiglottic ligament and conus elasticus. The larynx contains the vocal folds and is involved in sound production and airway protection during breathing and swallowing.
This document provides an overview of laryngeal anatomy, pathology, investigations, and staging of laryngeal cancers. It describes the cartilages, ligaments, muscles, blood supply, innervation, and histology of the larynx. Common sites of laryngeal cancer are discussed along with patterns of spread. Investigations for laryngeal cancer including laryngoscopy, CT, MRI, and direct laryngoscopy are summarized. Staging of laryngeal cancers is also reviewed briefly.
The document discusses the anterolateral thigh (ALT) flap, which was first introduced in 1984 for reconstruction. It has since become popular for head and neck reconstructions. The ALT flap has reliable anatomy based on the descending branch of the lateral circumflex femoral artery. It provides a long vascular pedicle and large skin paddle. While it has some disadvantages like a bulky flap, the ALT flap allows minimal donor site morbidity and rapid post-operative recovery.
The document describes the cartilages that make up the larynx. It details the location, shape, attachments and functions of the thyroid, cricoid, epiglottis, arytenoid, corniculate and cuneiform cartilages. The thyroid cartilage is the largest and forms an angle that is more acute in males, giving them a more prominent laryngeal prominence called the Adam's apple. The cricoid forms a ring below the thyroid. Together these cartilages provide structure and attachments for the muscles controlling the larynx.
The document discusses the surgical anatomy of the masseter muscle and facial nerve. It notes the relationships of the masseter muscle anteriorly, posteriorly, laterally, and medially. It then describes the surgical approach for locating the facial nerve, which involves making an incision in front of the ear tragus and dissecting through tissue to identify the styloid process as the first landmark. Finally, it provides measurements for distances between branches of the facial nerve and bony landmarks to help surgeons locate the nerve during procedures.
Properties of Denture base materials /rotary endodontic coursesIndian dental academy
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.for more details please visit
www.indiandentalacademy.com
Diagnosis and treatment planning in completely endntulous arches/dental coursesIndian dental academy
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.for more details please visit
www.indiandentalacademy.com
Cytotoxicity of silicone materials used in maxillofacial prosthesis / dental ...Indian dental academy
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.for more details please visit
www.indiandentalacademy.com
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.for more details please visit
www.indiandentalacademy.com
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.for more details please visit
www.indiandentalacademy.com
The forehead flap is a versatile flap used for reconstructing various facial defects. It has reliable blood supply from branches of the superficial temporal artery. The flap can be raised in different planes and tunneled to reach intraoral defects. It is commonly used in a two-stage procedure for nasal reconstruction, where the flap is first transferred to the defect and then the pedicle is divided later. Pre-expansion of the donor site can increase the available skin but comes with disadvantages like delaying the repair.
This document discusses the forehead flap procedure. It provides background on the history and anatomy of the forehead flap, which is based on the superficial temporal artery and its branches. The forehead flap can be used to reconstruct large defects in the nose, eyelids, cheeks, mouth, chin, and tongue. The technique involves outlining the flap based on the eyebrows and behind the ear. A tunnel is constructed to pass the flap to the defect site, either directly through the cheek or deep to the zygomatic arch. The donor site is closed primarily while the flap is monitored, with a second surgery needed to divide and close the bridge of the flap. Complications are rare given the rich blood supply but include infection, nerve injury, and
POST ONCOSURGICAL HEAD NECK RECONSTRUCTION - harsh aminHarsh Amin
This document discusses head and neck cancer reconstruction using free flaps. It begins by outlining the anatomy of the head and neck region and factors to consider for reconstruction such as integrity, function and form. Common free flap options are described including the anterolateral thigh flap, radial forearm flap, rectus abdominis flap, fibula flap and jejunum flap. Key steps in planning a reconstruction including evaluating the defect, donor site, patient factors and surgical experience are highlighted. The importance of microvascular expertise and equipment for free flap reconstruction is emphasized.
The radial forearm flap is based on the radial artery and its venae comitantes. It can be harvested as a fasciocutaneous or osteocutaneous flap with a long vascular pedicle. The radial forearm flap is commonly used in reconstructive surgery due to its reliable vascular anatomy, long pedicle length allowing for versatile positioning, and ability to provide a hairless skin match. Potential donor site complications include functional impairment and need for skin grafting or local flaps.
The document discusses the rectus abdominis flap, which is used in reconstructive surgery. It has reliable blood supply from the deep inferior and superior epigastric arteries. The flap can be harvested as a muscle flap, myocutaneous flap with skin island, or perforator flap. It has advantages like reliable anatomy and versatile design, and disadvantages like potential abdominal wall weakening. Preoperative planning includes assessing vascular supply and flap design involves anatomical landmarks. The flap can be harvested or modified in different ways and has applications in breast and other reconstructive procedures.
Head and neck cancer reconstruction is arguably the
most challenging area of reconstruction for the reconstructive
surgeon. A clear understanding of the principles of use of local flaps and a comprehensive understanding of the anatomy of these flaps provides the head and neck surgeon with a plethora of local and regional options for primary and secondary reconstruction.
The muscles of mastication include the masseter, temporalis, medial pterygoid, and lateral pterygoid muscles. These primary muscles elevate, protrude, retract, and move the mandible laterally during chewing. The masseter muscle originates on the zygomatic arch and inserts on the mandible ramus. The temporalis muscle originates broadly on the temporal fossa and inserts into the coronoid process and mandible. The medial and lateral pterygoid muscles both originate on pterygoid processes and insert on the mandible ramus and condyle, respectively. Secondary muscles like the digastric and mylohyoid also assist in mastication by depressing
This document provides information on the fibular free flap (FFF), including its anatomy, surgical technique, and applications. Some key points:
- The FFF is based on the peroneal artery and its venae comitantes. It provides a vascularized segment of bone for reconstruction, often of the mandible or maxilla.
- Important anatomical structures include the fibula itself, the peroneal muscles, and perforating vessels that pass through the posterior crural septum to supply the skin.
- Surgical steps include marking the donor leg, elevating the skin and muscle cuff, performing osteotomies, and harvesting the vascular pedicle containing artery and vein(s).
The document discusses scalp anatomy and reconstruction of scalp defects using flap procedures. It describes the layers of the scalp, blood supply, nerve supply and causes of scalp defects. Various reconstruction options are summarized including primary closure, skin grafting, local flaps such as rotation and transposition flaps, regional flaps such as trapezius flaps, and free tissue transfer including latissimus dorsi flaps. Factors to consider for reconstruction include the location and size of the defect, surrounding tissues, and preservation of the native hairline.
The document discusses the anatomy of the anterolateral abdominal wall. It describes the five muscles that make up the anterolateral wall - the external oblique, internal oblique, transversus abdominis, rectus abdominis, and pyramidalis. It details the structure, function and innervation of these muscles. The document also discusses the blood supply, lymphatic drainage and applied clinical considerations like different types of hernias related to weaknesses in the abdominal wall.
The document describes the pectoralis major island flap technique. It can be used for reconstruction of the pharynx, tongue, face, neck, and skullbase defects. The flap has a large arc of rotation from the clavicle to the xiphoid process. It provides a single stage transfer with a muscle carrier but does not match the color and texture of facial skin. The document outlines the surgical technique including flap design, elevation of the vascular pedicle, and closure of the donor site. Variations including osteomyocutaneous flaps with rib bone and use of the flap as a free tissue transfer are also discussed. Complications, risk factors, and modifications to the technique are summarized.
The document describes the anterolateral thigh flap, noting its arterial supply from branches of the descending branch of the lateral circumflex femoral artery, venous drainage by venae comitantes, and versatility in providing skin, fascia, muscle or combinations as a pedicled or free flap. The anterolateral thigh flap has become a workhorse flap due to its reliable anatomy, long vascular pedicle, ability to incorporate different tissue components, and minimal donor site morbidity.
The radial forearm flap is based on the radial artery and its venae comitantes. It has a long history of use since the 1970s for reconstructing various head and neck, facial, and extremity defects. The radial forearm flap has reliable anatomy, can be harvested as a pedicle or free flap, and provides a thin, pliable skin that is well-suited for reconstruction. The flap is elevated along a fascial plane, with the radial artery and venae comitantes preserved. While it is very reliable, complications can include tendon tethering, infection, and donor site morbidity like weakness or pain.
Muscles of the axial skeleton. Pictures of the muscles, origins, insertions, actions. Does not include all the muscles we discussed in class, but includes some fun photos & side notes.
The document provides an overview of the anatomy of the larynx. It discusses the framework of cartilages including the thyroid, cricoid, and arytenoid cartilages. It describes the ligaments and joints that connect the cartilages, including the cricothyroid joint and cricoarytenoid joint. It summarizes the divisions of the larynx including the supraglottis, glottis, and subglottis, and details the structures that make up each region such as the true and false vocal folds.
This document provides an overview of surgical incisions and abdominal wall anatomy relevant to urological surgery. It describes the layers of the abdominal wall including skin, fascia and muscles. It then classifies and describes various incision types for accessing the urinary system including flank, anterior abdominal, thoracoabdominal and midline incisions. Key abdominal wall muscles like the rectus abdominis and their innervation are also defined.
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Indian Dental Academy
Leader in continuing dental education
www.indiandentalacademy.com
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+919248678078
Use of modified tooth forms in complete denture occlusion / dental implant...Indian dental academy
This document discusses dental occlusion concepts and philosophies for complete dentures. It introduces key terms like physiologic occlusion and defines different occlusion schemes like balanced articulation and monoplane articulation. The document discusses advantages and disadvantages of using anatomic versus non-anatomic teeth for complete dentures. It also outlines requirements for maintaining denture stability, such as balanced occlusal contacts and control of horizontal forces. The goal of occlusion for complete dentures is to re-establish the homeostasis of the masticatory system disrupted by edentulism.
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.for more details please visit
www.indiandentalacademy.com
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.for more details please visit
www.indiandentalacademy.com
This document discusses dental casting investment materials. It describes the three main types of investments - gypsum bonded, phosphate bonded, and ethyl silicate bonded investments. For gypsum bonded investments specifically, it details their classification, composition including the roles of gypsum, silica, and modifiers, setting time, normal and hygroscopic setting expansion, and thermal expansion. It provides information on how the properties of gypsum bonded investments are affected by their composition. The document serves as a comprehensive overview of dental casting investment materials.
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.for more details please visit
www.indiandentalacademy.com
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.for more details please visit
www.indiandentalacademy.com
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.for more details please visit
www.indiandentalacademy.com
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.for more details please visit
www.indiandentalacademy.com
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.for more details please visit
www.indiandentalacademy.com
Dentalcasting alloys/certified fixed orthodontic courses by Indian dental aca...Indian dental academy
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.for more details please visit
www.indiandentalacademy.com
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.for more details please visit
www.indiandentalacademy.com
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.for more details please visit
www.indiandentalacademy.com
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.for more details please visit
www.indiandentalacademy.com
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.for more details please visit
www.indiandentalacademy.com
Denture base and teeth /orthodontic courses by Indian dental academy Indian dental academy
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.for more details please visit
www.indiandentalacademy.com
Executive Directors Chat Leveraging AI for Diversity, Equity, and InclusionTechSoup
Let’s explore the intersection of technology and equity in the final session of our DEI series. Discover how AI tools, like ChatGPT, can be used to support and enhance your nonprofit's DEI initiatives. Participants will gain insights into practical AI applications and get tips for leveraging technology to advance their DEI goals.
How to Build a Module in Odoo 17 Using the Scaffold MethodCeline George
Odoo provides an option for creating a module by using a single line command. By using this command the user can make a whole structure of a module. It is very easy for a beginner to make a module. There is no need to make each file manually. This slide will show how to create a module using the scaffold method.
This presentation includes basic of PCOS their pathology and treatment and also Ayurveda correlation of PCOS and Ayurvedic line of treatment mentioned in classics.
The simplified electron and muon model, Oscillating Spacetime: The Foundation...RitikBhardwaj56
Discover the Simplified Electron and Muon Model: A New Wave-Based Approach to Understanding Particles delves into a groundbreaking theory that presents electrons and muons as rotating soliton waves within oscillating spacetime. Geared towards students, researchers, and science buffs, this book breaks down complex ideas into simple explanations. It covers topics such as electron waves, temporal dynamics, and the implications of this model on particle physics. With clear illustrations and easy-to-follow explanations, readers will gain a new outlook on the universe's fundamental nature.
Strategies for Effective Upskilling is a presentation by Chinwendu Peace in a Your Skill Boost Masterclass organisation by the Excellence Foundation for South Sudan on 08th and 09th June 2024 from 1 PM to 3 PM on each day.
Macroeconomics- Movie Location
This will be used as part of your Personal Professional Portfolio once graded.
Objective:
Prepare a presentation or a paper using research, basic comparative analysis, data organization and application of economic information. You will make an informed assessment of an economic climate outside of the United States to accomplish an entertainment industry objective.
Assessment and Planning in Educational technology.pptxKavitha Krishnan
In an education system, it is understood that assessment is only for the students, but on the other hand, the Assessment of teachers is also an important aspect of the education system that ensures teachers are providing high-quality instruction to students. The assessment process can be used to provide feedback and support for professional development, to inform decisions about teacher retention or promotion, or to evaluate teacher effectiveness for accountability purposes.
Exploiting Artificial Intelligence for Empowering Researchers and Faculty, In...Dr. Vinod Kumar Kanvaria
Exploiting Artificial Intelligence for Empowering Researchers and Faculty,
International FDP on Fundamentals of Research in Social Sciences
at Integral University, Lucknow, 06.06.2024
By Dr. Vinod Kumar Kanvaria
A Strategic Approach: GenAI in EducationPeter Windle
Artificial Intelligence (AI) technologies such as Generative AI, Image Generators and Large Language Models have had a dramatic impact on teaching, learning and assessment over the past 18 months. The most immediate threat AI posed was to Academic Integrity with Higher Education Institutes (HEIs) focusing their efforts on combating the use of GenAI in assessment. Guidelines were developed for staff and students, policies put in place too. Innovative educators have forged paths in the use of Generative AI for teaching, learning and assessments leading to pockets of transformation springing up across HEIs, often with little or no top-down guidance, support or direction.
This Gasta posits a strategic approach to integrating AI into HEIs to prepare staff, students and the curriculum for an evolving world and workplace. We will highlight the advantages of working with these technologies beyond the realm of teaching, learning and assessment by considering prompt engineering skills, industry impact, curriculum changes, and the need for staff upskilling. In contrast, not engaging strategically with Generative AI poses risks, including falling behind peers, missed opportunities and failing to ensure our graduates remain employable. The rapid evolution of AI technologies necessitates a proactive and strategic approach if we are to remain relevant.
it describes the bony anatomy including the femoral head , acetabulum, labrum . also discusses the capsule , ligaments . muscle that act on the hip joint and the range of motion are outlined. factors affecting hip joint stability and weight transmission through the joint are summarized.
A workshop hosted by the South African Journal of Science aimed at postgraduate students and early career researchers with little or no experience in writing and publishing journal articles.
This slide is special for master students (MIBS & MIFB) in UUM. Also useful for readers who are interested in the topic of contemporary Islamic banking.
Azure Interview Questions and Answers PDF By ScholarHat
Local and regional flaps in head & neck cancer /certified fixed orthodontic courses by Indian dental academy
1. Local and Regional Flaps In
Head and Neck Cancer
INDIAN DENTAL ACADEMY
Leader in continuing dental education
www.indiandentalacademy.com
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5.
large fan-shaped muscle that covers much of the
anterior thoracic wall. To a variable extent, it overlies
the pectoralis minor, subclavius, serratus anterior,
and intercostal muscles.
origins -three portions.
1 cephalad -medial third of the clavicle.
2 central,-sternocostal-sternum &cartilages of
the first six ribs
3 aponeurosis of the external oblique, is
variable in size.
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7. PECTORALIS MAJOR MYOCUTANEOUS FLAP
Superior and lateral
thoracic arteries additional pedicles
Overlying skin
additionally supplied by
intercostal perforators
3 subunits each with its
own vascular & motor
supply
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8. functions
adduct and medially rotate the arm
It becomes active in internal rotation of the arm only
when working against resistance.
upper muscle fibers help to flex the arm to the
horizontal level; the lower fibers assist in arm
extension.
Contraction helps to extend the arm to the individual's
side, but it plays no role in hyperextension beyond that
point.
loss of the dynamic activity of the pectoralis major
appears to be well tolerated
Much of the adductor activity is compensated for by
the powerful, latissimus dorsi muscle, which makes up
the posterior axillary fold.
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10. PECTORALIS MAJOR MYOCUTANEOUS FLAP
ADVANTAGES
One stage
Generous portion of skin & soft tissue(400cm2)
Consistent blood supply – highly reliable
Adequate arc of rotation for facial defects
Donor site can be closed primarily
Two skin islands on the same muscle paddle
Protects the carotid artery
Technically, the flap is ease to elevate
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11. PECTORALIS MAJOR MYOCUTANEOUS FLAP
DISADVANTAGES
Arc of rotation limited for oromaxillary defects
It can be too bulky
There is distortion of symmetry at the donor
site
Shoulder function is impaired
Distal skin of the flap is not reliable
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12. Methods to Improve the Arc of
Rotation
Ariyan's -incorporated a long segment of skin that
extended from the clavicle to the caudal extent of
the muscle.
Distal skin paddle placed over the caudal extent of
the muscle
Maghee- skin paddle extended over rectus
abdominus
Lee and Lore -removal of a segment of the clavicle
to gain up to 3 cm of length.
Wilson et al. -tunneling the muscle pedicle deep to
the clavicle in a subperiosteal plane .
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14. Methods to Deal with Excessive Bulk
Sharzer et al. - harvesting a vertically
oriented "parasternal” skin paddle that
extended across the sternum to the opposite
internal mammary perforators.
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15. Methods to Deal with Excessive Bulk
Murakami et al. -eliminating the skin paddle
entirely.
two-stage procedure
a split-thickness skin graft was placed
over the muscle 3 to 4 weeks later harvest
the muscle-skin graft unit.
Maintain nerve supply or not
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16. Methods to Achieve Two Epithelial Surfaces for
Reconstruction of Compound Defects
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18. POTENTIAL PITFALLS
Incidence of total flap necrosis was reported
to be 1.0%, 1.5%, 3%, and 7%.
Partial flap necrosis- 14%-30%
Pedicle compression
In male patients may lead to problems with
excessive hair growth in the oral cavity or
pharynx
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20. TEMPORALIS MUSCLE FLAP
Golovine 1898 - orbital
exenteration
Gilles - reanimation of
paralyzed face
Fan - shaped muscle
arising from temporal fossa
& the superior temporal line
The muscle is bipennate,
with an additional superficial
origin from the temporalis
fascia
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21. TEMPORALIS MUSCLE FLAP
Main blood supply - anterior &
posterior deep temporal artery
Anterior deep temporal artery &
Posterior deep temporal enter the
muscle approximately 1cm
anterior & 1.7cm posterior to
coronoid process respectively
This vascular anatomy allows
splitting of muscle into anterior &
posterior flap
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22. TEMPORALIS MUSCLE FLAP
Mobilized flap consists of
fascia, muscle, & pericranium
Two distinct fascial layers, the
superficial & deep temporal
fascia
Superficial temporal fascia is a
thin, highly vascular layer of
moderately dense Connective
tissue
The absence of vascularity
between this two layers
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23. TEMPORALIS MUSCLE FLAP
Hemicoronal flap provides excellent access
Incision ends above the superior temporal line
Dissections proceeds down to the deep temporal fascia until the
entire muscle is exposed
Dissection in this plane protects the temporal branch of facial
nerve
Reflection of the muscle of the temporal bone should be performed
in a strict subperiosteal plane
Rotation can be improved by dividing ZA & base of the coronoid
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24. TEMPORALIS MUSCLE FLAP
If the muscle is split in coronal plane posterior
portion of muscle is transposed anteriorly
Donor site - secondarily reconstructed by
alloplastic implants
Alopecia avoided by careful placement of
coronal incision parallel to hair shaft
Bradley & Brock hank - flap does not require
skin grafting & rapid mucolization occur
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25.
It is relatively short (3 to 5 cm) and thin (2 to
3mm) and has a contraction capability of 1 to
1.5 cm
flap has a rotational radius of 8 cm
it is possible to cover defects of the mastoid,
cheek, pharynx, and palate.
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26. TEMPORALIS MUSCLE FLAP
ADVANTAGES
Ease of elevation
Reliable blood supply
Proximity
Camouflage of incision
with in hair line
Muscle support graft &
alloplast well
DISADVANTAGES
Sensory disturbances
Potential facial nerve
injury
Temporal hallowing
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30. STERNOCLEDOMASTOID MYOCUTANEOUS FLAP
Long strap muscle
Muscular origin Tendinous
origin
Insertion
Branch of spinal accessory
nerve
Dominant blood supply –
branches of occipital artery
& its draining vein
Middle third of the muscle
Inferior third of the muscle
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31. STERNOCLEDOMASTOID MYOCUTANEOUS FLAP
REPORTED INDICATIONS
Provision of epithelial lining for mucosal
reconstruction
Closure of orocutaneous fistulas
Release of scar contracture in submandibular &
angle region
Provision of additional vascularized tissue around a
bone graft when the tissue bed has been heavily
irradiated
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32. STERNOCLEDOMASTOID MYOCUTANEOUS FLAP
Superior blood supply
6 x 8 cm paddle of skin
Skin paddle should be kept
overlying the muscle above
the level of clavicle
Skin paddle is tacked down
to the muscle fascia
Muscle dissected &
elevated by incising the
fascia
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33. STERNOCLEDOMASTOID MYOCUTANEOUS FLAP
Inferior blood supply
Branches of superior
thyroid artery are noted
to enter the anterior
aspect of muscle at the
level of carotid
bifurcation
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34. MASSETER FLAP
Lexer and Eden in 1911
Short, flat, thick quadrangular
muscle
Superior belly - downwards &
backwards
Deep belly - vertically & slightly
forwards
Massetric nerve & artery
Hemimandiblectemy. suturing
the masseter to the hyoid bone
to assist in laryngeal elevation
during swallowing.
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35.
Does not restore emotional mimetic
movements
Muscle eliminated in extensive ablative
surgery
Limited in size & volume
Does not have skin paddle
Restricted arc of rotation
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36. DELTOPECTORAL FLAP
First axial pattern skin flap
The base of flap is parasternal includes the first three
or four perforating branches of internal mammary
artery, second perforator is largest
Artery as rich anastomosis, accompanied by Vein
It extend laterally over the upper chest at the level of
clavicle on to the deltoid muscle & shoulder
Width 8 - 12 cm, Length 18 - 22 cm
reverse of deltopectoral flap - Thoracoacromial flap
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38. DELTOPECTORAL FLAP
DISADVANTAGES
Donor site require skin grafting
Moderate amount of scarring & deformity is
unacceptable in women
Physiologic disadvantage in malnourished patient or
post operative irradiation
Flap should not be used if previous scarring on
donor area
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39. DELTOPECTORAL FLAP
Superior incision is placed just below the clavicle
inferior one run parallel to it
Flap raised from lateral extent medially
Incision is carried down through the pectoral fascia
Plane of dissection is sub fascial
Dissection proceeds up to 2 cm of lateral border of
sternum
Back cut on medial aspect - improve the flap rotation
90% success rate
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41. PLATYSMA FLAP
Extremely thin band like & variable muscle
forming superficial boundary of neck
Arises from clavicle superiorly continues with
the attachment to the mandible
Submental branch of the facial artery
Flap size
Muscle - 10 x 10 cm to 10 x 20 cm
skin paddle - 3 x 6 cm to 6 x 20 cm
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42. PLATYSMA FLAP
ADVANTAGES
Proximity & Regionality
Thin & delicate
Reliable when vascu-lar criteria adhered
Arc of rotation - 180
No donor site disability
DISADVANTAGES
Lack of bulk
Hair bearing in male
Reliability 85%
Complication like skin
loss & fistula
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43. TRAPEZIUS FLAP
Mutter 1842
Originally described as
superior based cutaneous
flap
Flat & triangular and cover
the superoposterior aspect of
the neck & shoulder
Dominant pedicle, the
transverse cervical artery
Functions to rotate the
scapula & to elevate, rotate &
adduct upper arm
10 x 20 cm in size
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44. TRAPEZIUS FLAP
Lateral positioning of patient
to elevate flap
Ideally suited for radical
parotidectomy
Limited to small defects in
oral cavity
Generous amount of soft
tissue & large portion of
skin island
90 – 95 % of success
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45. TRAPEZIUS FLAP
ADVANTAGES
Flap is versatile
Regionality of flap
Strong vascular security
Supplies considerable bulk
Arc of rotation 90 – 180 degree
One stage procedure
Minimum deficit at donor area
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46. TRAPEZIUS FLAP
DISADVANTAGES
Venous system difficult to preserve
Vascular supply in general difficult to preserve
Can present with excessive bulk
Cannot be easily tubed
Moderate shoulder drop postoperatively
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47. LATISSIMUS DORSI MYOCUTANEOUS FLAP
Distant flap, provides largest possible skin paddle,
involves the most complex donor site dissection,
and arc of rotation extremely versatile
Donor site skin paddle measures 40 by 25 cm & still
allows primary closure
The latissimus dorsi is very broad muscle of the
back with a fascial origin from T7 to T12, from the
lumbar & sacral vertebrae, from posterior crest of
the ilium & also minor origination from the last four
ribs
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48. LATISSIMUS DORSI MYOCUTANEOUS FLAP
Insertion on the intertubercular groove of the
humerus
Extend, adduct, & medially rotate the arm
Major pedicle is thoracodorsal artery, a
terminal branch of the subscapular artery
Perforators enter the muscle medially along
the spine – secondary supply
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49. LATISSIMUS DORSI MYOCUTANEOUS FLAP
ADVANTAGES
Size – largest flap in
the body
Flap location
Arc of rotation - 180
Large, reliable
unicentric
neurovascular pedicle
Donor area
90% success rate
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50. LATISSIMUS DORSI MYOCUTANEOUS FLAP
DISADVANTAGES
Repositioning of the patient
Skin paddle is thick & has strong attachment
to the underlying muscle
Considerable bulk – postoperative sagging &
pendulosity
Donor area may need skin graft
It is in competition with other very suitable
flaps
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51. conclusion
Success in reconstruction of the craniofacial
region by local and regional flaps requires
knowledge ,careful preop planning, skilled
tecqniques, and meticulous care after
operation
The goal is to return the patient as closely as
possible to the preop aesthetic and functional
level
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53. REFERENCES
Oral and Maxillofacial surgery clinics of North America November
1993
Flaps in Head and Neck Surgery 1989 John Conley and Carl Patow
Oral cancer Jatin P shah
GRABB’S Encyclopedia of flaps Volume 1
Maxillofacial Surgery Vol. 1 Peter Ward Booth
Atlas of Regional and Free Flaps for head and neck reconstruction
Mark L. Urken
Plastic surgery –McCarthy.vol-1
Fonseca –OMFS Vol-7
Mastery in plastic and reconstructive surgery-Mimis Cohen
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54. REFERENCES
Oral and Maxillofacial surgery clinics of North
America NOVEMBER 1993
Flaps in Head and Neck Surgery 1989
John
Conley and Carl Patow
Oral cancer Jatin P shah
GRABB’S Encyclopedia of flaps
Maxillofacial Surgery Vol. 1 Peter Ward Booth
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