This document describes the arterial blood supply to the lower limbs and various flap options based on these arteries. It outlines the vascular anatomy of arteries like the femoral artery and its branches, including the lateral circumflex femoral artery. It then provides details on specific musculocutaneous and fasciocutaneous flap options based on these arteries, such as the anteromedial thigh flap, anterolateral thigh flap, gracilis flap, and hamstring flaps.
The document provides information on the anatomy of the lower limb, including details on the nerves, muscles, arteries and veins. It discusses the femoral, obturator, sciatic, tibial and common fibular nerves, and describes their motor and sensory innervation. Injuries to these nerves such as lacerations or compressions are outlined. Various conditions affecting the lower limb like sciatica, piriformis syndrome and iliotibial band syndrome are also summarized. Procedures such as femoral artery catheterization and risks of intramuscular injections are covered as well.
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.
The document discusses several muscle flaps that can be used for coverage of infected vascular grafts, including the sartorius, gracilis, rectus femoris, tensor fascia lata, and rectus abdominis muscles. It also discusses using the greater omentum. Each option has advantages and disadvantages in terms of blood supply, size, and functional implications. The sartorius is frequently used due to its reliable segmental blood supply and proximity to the groin. The gracilis is suitable for smaller defects while the rectus femoris and tensor fascia lata are good for more extensive coverage.
This document contains questions and answers related to the anatomy of the upper limb. It begins by listing structures that pass through various spaces in the arm and forearm, such as the brachial artery and median nerve passing through the cubital fossa. It then covers the muscles, nerves, arteries and veins of the upper limb in more detail, describing their origins, innervations and relationships to surrounding structures. Key areas discussed include the shoulder, axilla, elbow, and the anterior and posterior compartments of the forearm.
The popliteal fossa is a diamond-shaped space located behind the knee. It contains the popliteal artery and vein, the tibial and common peroneal nerves, and popliteal lymph nodes. The boundaries of the fossa include muscles like the biceps femoris, semimembranosus, and gastrocnemius. The contents of the fossa are vulnerable due to the fossa's location and proximity to the surface.
The popliteal fossa is located behind the knee and has several important structures passing through it. The fossa is bounded superiorly by the biceps tendon and semimembranosus muscle, and inferiorly and laterally by the two heads of the gastrocnemius muscle. The roof of the fossa is formed by the fascia lata. Within the fossa pass the common peroneal nerve, tibial nerve, popliteal vessels, and popliteal lymph nodes, with the popliteal artery deepest and the popliteal vein and tibial nerve more superficial.
The carotid triangle is a vascular area in the neck bounded by the omohyoid muscle, digastric muscle, and sternocleidomastoid muscle. It contains the common carotid artery and its branches, internal jugular vein, vagus and other cranial nerves. The common carotid artery divides at the upper border of the thyroid cartilage into the internal and external carotid arteries. The posterior belly of the digastric muscle crosses superficial to the internal jugular vein and carotid vessels in the triangle.
The anterior tibial artery is a terminal branch of the popliteal artery that supplies the anterior compartment of the leg. It originates below the popliteus muscle and courses vertically down the leg between muscle compartments before becoming the dorsalis pedis artery. It gives off branches that anastomose around the knee and ankle joints. The posterior tibial artery is the larger terminal branch of the popliteal artery, supplying the posterior and lateral leg compartments and sole of the foot. It travels behind the tibia and fibula, giving muscular and nutrient branches before terminating as the medial and lateral plantar arteries. Throughout its course it is accompanied by the tibial nerve.
The document provides information on the anatomy of the lower limb, including details on the nerves, muscles, arteries and veins. It discusses the femoral, obturator, sciatic, tibial and common fibular nerves, and describes their motor and sensory innervation. Injuries to these nerves such as lacerations or compressions are outlined. Various conditions affecting the lower limb like sciatica, piriformis syndrome and iliotibial band syndrome are also summarized. Procedures such as femoral artery catheterization and risks of intramuscular injections are covered as well.
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.
The document discusses several muscle flaps that can be used for coverage of infected vascular grafts, including the sartorius, gracilis, rectus femoris, tensor fascia lata, and rectus abdominis muscles. It also discusses using the greater omentum. Each option has advantages and disadvantages in terms of blood supply, size, and functional implications. The sartorius is frequently used due to its reliable segmental blood supply and proximity to the groin. The gracilis is suitable for smaller defects while the rectus femoris and tensor fascia lata are good for more extensive coverage.
This document contains questions and answers related to the anatomy of the upper limb. It begins by listing structures that pass through various spaces in the arm and forearm, such as the brachial artery and median nerve passing through the cubital fossa. It then covers the muscles, nerves, arteries and veins of the upper limb in more detail, describing their origins, innervations and relationships to surrounding structures. Key areas discussed include the shoulder, axilla, elbow, and the anterior and posterior compartments of the forearm.
The popliteal fossa is a diamond-shaped space located behind the knee. It contains the popliteal artery and vein, the tibial and common peroneal nerves, and popliteal lymph nodes. The boundaries of the fossa include muscles like the biceps femoris, semimembranosus, and gastrocnemius. The contents of the fossa are vulnerable due to the fossa's location and proximity to the surface.
The popliteal fossa is located behind the knee and has several important structures passing through it. The fossa is bounded superiorly by the biceps tendon and semimembranosus muscle, and inferiorly and laterally by the two heads of the gastrocnemius muscle. The roof of the fossa is formed by the fascia lata. Within the fossa pass the common peroneal nerve, tibial nerve, popliteal vessels, and popliteal lymph nodes, with the popliteal artery deepest and the popliteal vein and tibial nerve more superficial.
The carotid triangle is a vascular area in the neck bounded by the omohyoid muscle, digastric muscle, and sternocleidomastoid muscle. It contains the common carotid artery and its branches, internal jugular vein, vagus and other cranial nerves. The common carotid artery divides at the upper border of the thyroid cartilage into the internal and external carotid arteries. The posterior belly of the digastric muscle crosses superficial to the internal jugular vein and carotid vessels in the triangle.
The anterior tibial artery is a terminal branch of the popliteal artery that supplies the anterior compartment of the leg. It originates below the popliteus muscle and courses vertically down the leg between muscle compartments before becoming the dorsalis pedis artery. It gives off branches that anastomose around the knee and ankle joints. The posterior tibial artery is the larger terminal branch of the popliteal artery, supplying the posterior and lateral leg compartments and sole of the foot. It travels behind the tibia and fibula, giving muscular and nutrient branches before terminating as the medial and lateral plantar arteries. Throughout its course it is accompanied by the tibial nerve.
6. fascial spaces and arterial anastomoses of the upper limbDr. Mohammad Mahmoud
The document summarizes the fascial spaces and arterial anatomy of the upper limb. It describes the boundaries and contents of fascial spaces in the palm, fingers, forearm, and elbow. It also outlines important arterial anastomoses around the shoulder, elbow, wrist, and hand that help ensure adequate blood flow, including the palmar and dorsal carpal arches and the superficial and deep palmar arches.
The popliteal fossa contains important neurovascular structures. It is bounded by the femur and tibia. The tibial nerve and common peroneal nerve pass through the fossa along with the popliteal artery and vein. Lymphatic drainage from the lower leg travels to lymph nodes in the popliteal fossa. The relationships between the nerves, veins and artery change along the course of the fossa, with the nerves being most superficial and the artery deepest.
The document discusses the anatomy of the upper limb, brachial plexus, and scapular region. The brachial plexus is formed by the lower cervical and upper thoracic spinal nerves and provides motor and sensory innervation to the upper limb. It is located in the axilla and gives rise to the major nerves of the arm. The axillary artery originates from the subclavian artery and gives rise to vessels that supply the upper limb before terminating as the brachial artery in the arm. Veins in the upper limb drain into the axillary and brachial veins. Key muscles of the scapular region include the deltoid, teres major, triceps brachii
This document provides an overview of the diaphragm. It discusses that the diaphragm is the main muscle of respiration that separates the chest cavity from the abdominal cavity. The diaphragm has a dome shape with a peripheral muscular part and a central tendon. It originates from the xiphoid process, lower six ribs, and vertebral columns. The diaphragm inserts into a central tendon that is fused to the pericardium. It is the most important muscle for breathing movements.
The document describes the anatomy of the palm of the hand. It discusses the skin, nerves, muscles and fascia of the palm. The palmaris brevis muscle covers and protects the base of the hypothenar eminence. The deep fascia forms the flexor retinaculum and palmar aponeurosis. The flexor retinaculum converts the front of the wrist into the carpal tunnel. The palmar aponeurosis divides into bands that attach to the skin and flexor tendon sheaths. The document also outlines the small muscles of the hand including the thenar, hypothenar and interossei muscles.
The posterior compartment of the thigh contains the hamstring muscles (biceps femoris, semitendinosus, semimembranosus, and part of the adductor magnus), which are supplied by branches from the sciatic nerve. It also contains cutaneous nerves that innervate the skin (medial, posterior, and lateral cutaneous nerves) and veins that drain into the great and small saphenous veins. The blood supply comes from branches of the profunda femoris artery and drains into the profunda femoris vein.
A summary for learning the muscles of the upper limb including their attachments, innervation, etc., without having to have too many books open. Resources: "Gray’s Anatomy", "Taschenatlas der Anatomie" and Wikipedia. Awaiting further proof-reading!
The document summarizes the blood vessels and lymphatics of the thoracic wall. It describes the arteries, veins and lymphatic drainage of the intercostal spaces and chest wall. The posterior intercostal arteries arise from the subclavian artery or descending thoracic aorta and supply the thoracic wall and parietal pleura. The posterior intercostal veins drain into the azygos or hemiazygos veins. Lymph from the chest wall drains to the anterior and posterior axillary nodes or internally to the thoracic nodes along the internal thoracic artery.
This document provides information about anatomy of the chest wall, thoracic cavity, lungs, heart and related structures. It covers topics such as layers of the thoracic wall, bones and muscles of the rib cage, structures passing through thoracic inlets and outlets, anatomy of breathing including the pleural membranes and diaphragm, vascular and lymphatic drainage of the chest, lobes and fissures of the lungs, structures within the mediastinum, and basic cardiac anatomy including the pericardium and internal structures of the atria and ventricles. The document is in a question and answer format to test knowledge of these anatomical structures and relationships.
The document discusses the deep fascia of the neck, which compartmentalizes the structures in the neck into four major fascial compartments. The deep fascia consists of three layers - the investing layer, pretracheal layer, and prevertebral layer. The investing layer surrounds the neck, while the pretracheal layer encloses the infrahyoid muscles, thyroid gland, trachea, and esophagus. The prevertebral layer forms a sheath for the vertebral column and associated deep cervical muscles. Between these layers are the neurovascular compartments containing the carotid arteries, internal jugular veins, vagus nerves and deep cervical lymph nodes.
This document describes the anatomy of the front of the thigh. It details the cutaneous nerves, muscles in the anterior compartment including the pectineus, sartorius and quadriceps femoris. It describes the femoral triangle containing the femoral vessels and nerve. The adductor canal containing the continuation of the femoral artery and vein is also summarized. Finally, the courses and branches of the femoral artery and vein are outlined.
1. The document describes the anatomy of the thoracic wall including bones, joints, muscles, blood vessels, and nerves.
2. It discusses the 12 pairs of ribs, their classification as true, false, or floating ribs, and their articulations with the sternum.
3. The intercostal spaces contain intercostal muscles like the external and internal intercostals that act in respiration, as well as vessels and nerves.
The thorax contains the organs of the respiratory and cardiovascular systems. It is bounded by the sternum, vertebrae, and ribs. Within the thoracic cavity are two pleural cavities housing the lungs and a central mediastinum containing the heart, great vessels, trachea and esophagus. The lungs, pleura, chest wall and mediastinal structures were described in detail.
The brachial artery is the continuation of the axillary artery in the arm. It begins at the lower border of the teres major muscle and ends in the cubital fossa by dividing into the radial and ulnar arteries. It passes down the anterior compartment of the arm and gives off branches including the profunda brachii artery. The brachial artery has important clinical significance as the brachial pulse is used to measure blood pressure and compressing it can help control hemorrhaging in the arm.
The document summarizes the major arteries of the upper limbs, including the axillary artery and its branches (thoracoacromial, lateral thoracic, circumflex humeral arteries), brachial artery and its branches (profunda brachii, ulnar collateral arteries), and the terminal branches - radial and ulnar arteries. It describes the course and branches of each artery as they supply structures in the arm, forearm, and hand.
The document summarizes the anatomy of the arteries of the forearm and hand. In the forearm, the ulnar and radial arteries are the two main arteries. The ulnar artery originates near the elbow and passes down the medial side of the forearm, while the radial artery originates from the brachial artery near the elbow and passes down the lateral side. In the hand, the ulnar and radial arteries form arches that supply blood to the digits. The superficial palmar arch is formed mainly by the ulnar artery and helps supply the palm.
The document summarizes the anatomy of the thoracic wall. It is formed posteriorly by thoracic vertebrae, laterally by ribs and intercostal spaces, and anteriorly by the sternum and costal cartilages. The intercostal spaces contain intercostal muscles and neurovascular bundles. The document further describes the layers of intercostal muscles, blood supply, innervation, and clinical procedures relevant to the thoracic wall.
The document provides an overview of the anatomy of the leg, including its bones, muscles, blood supply, innervation, and fascial compartments. It describes the tibia and fibula bones and notes the leg is divided into anterior, lateral, and posterior muscle compartments by fascia. The major muscles of each compartment and their actions are defined. The blood supply from branches of the popliteal artery and innervation from tibial and common fibular nerves are also summarized.
This document discusses principles of tendon transfers. Tendon transfers involve reattaching a functioning tendon to replace a paralyzed or injured tendon. Key points include indications such as nerve injuries or ruptured tendons. Donor tendons should match the amplitude, power, and function needed. Timing depends on factors like prognosis. Post-operative rehabilitation is important to regain motion and train new muscle functions. The goal is to restore useful hand function rather than just motion.
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.
6. fascial spaces and arterial anastomoses of the upper limbDr. Mohammad Mahmoud
The document summarizes the fascial spaces and arterial anatomy of the upper limb. It describes the boundaries and contents of fascial spaces in the palm, fingers, forearm, and elbow. It also outlines important arterial anastomoses around the shoulder, elbow, wrist, and hand that help ensure adequate blood flow, including the palmar and dorsal carpal arches and the superficial and deep palmar arches.
The popliteal fossa contains important neurovascular structures. It is bounded by the femur and tibia. The tibial nerve and common peroneal nerve pass through the fossa along with the popliteal artery and vein. Lymphatic drainage from the lower leg travels to lymph nodes in the popliteal fossa. The relationships between the nerves, veins and artery change along the course of the fossa, with the nerves being most superficial and the artery deepest.
The document discusses the anatomy of the upper limb, brachial plexus, and scapular region. The brachial plexus is formed by the lower cervical and upper thoracic spinal nerves and provides motor and sensory innervation to the upper limb. It is located in the axilla and gives rise to the major nerves of the arm. The axillary artery originates from the subclavian artery and gives rise to vessels that supply the upper limb before terminating as the brachial artery in the arm. Veins in the upper limb drain into the axillary and brachial veins. Key muscles of the scapular region include the deltoid, teres major, triceps brachii
This document provides an overview of the diaphragm. It discusses that the diaphragm is the main muscle of respiration that separates the chest cavity from the abdominal cavity. The diaphragm has a dome shape with a peripheral muscular part and a central tendon. It originates from the xiphoid process, lower six ribs, and vertebral columns. The diaphragm inserts into a central tendon that is fused to the pericardium. It is the most important muscle for breathing movements.
The document describes the anatomy of the palm of the hand. It discusses the skin, nerves, muscles and fascia of the palm. The palmaris brevis muscle covers and protects the base of the hypothenar eminence. The deep fascia forms the flexor retinaculum and palmar aponeurosis. The flexor retinaculum converts the front of the wrist into the carpal tunnel. The palmar aponeurosis divides into bands that attach to the skin and flexor tendon sheaths. The document also outlines the small muscles of the hand including the thenar, hypothenar and interossei muscles.
The posterior compartment of the thigh contains the hamstring muscles (biceps femoris, semitendinosus, semimembranosus, and part of the adductor magnus), which are supplied by branches from the sciatic nerve. It also contains cutaneous nerves that innervate the skin (medial, posterior, and lateral cutaneous nerves) and veins that drain into the great and small saphenous veins. The blood supply comes from branches of the profunda femoris artery and drains into the profunda femoris vein.
A summary for learning the muscles of the upper limb including their attachments, innervation, etc., without having to have too many books open. Resources: "Gray’s Anatomy", "Taschenatlas der Anatomie" and Wikipedia. Awaiting further proof-reading!
The document summarizes the blood vessels and lymphatics of the thoracic wall. It describes the arteries, veins and lymphatic drainage of the intercostal spaces and chest wall. The posterior intercostal arteries arise from the subclavian artery or descending thoracic aorta and supply the thoracic wall and parietal pleura. The posterior intercostal veins drain into the azygos or hemiazygos veins. Lymph from the chest wall drains to the anterior and posterior axillary nodes or internally to the thoracic nodes along the internal thoracic artery.
This document provides information about anatomy of the chest wall, thoracic cavity, lungs, heart and related structures. It covers topics such as layers of the thoracic wall, bones and muscles of the rib cage, structures passing through thoracic inlets and outlets, anatomy of breathing including the pleural membranes and diaphragm, vascular and lymphatic drainage of the chest, lobes and fissures of the lungs, structures within the mediastinum, and basic cardiac anatomy including the pericardium and internal structures of the atria and ventricles. The document is in a question and answer format to test knowledge of these anatomical structures and relationships.
The document discusses the deep fascia of the neck, which compartmentalizes the structures in the neck into four major fascial compartments. The deep fascia consists of three layers - the investing layer, pretracheal layer, and prevertebral layer. The investing layer surrounds the neck, while the pretracheal layer encloses the infrahyoid muscles, thyroid gland, trachea, and esophagus. The prevertebral layer forms a sheath for the vertebral column and associated deep cervical muscles. Between these layers are the neurovascular compartments containing the carotid arteries, internal jugular veins, vagus nerves and deep cervical lymph nodes.
This document describes the anatomy of the front of the thigh. It details the cutaneous nerves, muscles in the anterior compartment including the pectineus, sartorius and quadriceps femoris. It describes the femoral triangle containing the femoral vessels and nerve. The adductor canal containing the continuation of the femoral artery and vein is also summarized. Finally, the courses and branches of the femoral artery and vein are outlined.
1. The document describes the anatomy of the thoracic wall including bones, joints, muscles, blood vessels, and nerves.
2. It discusses the 12 pairs of ribs, their classification as true, false, or floating ribs, and their articulations with the sternum.
3. The intercostal spaces contain intercostal muscles like the external and internal intercostals that act in respiration, as well as vessels and nerves.
The thorax contains the organs of the respiratory and cardiovascular systems. It is bounded by the sternum, vertebrae, and ribs. Within the thoracic cavity are two pleural cavities housing the lungs and a central mediastinum containing the heart, great vessels, trachea and esophagus. The lungs, pleura, chest wall and mediastinal structures were described in detail.
The brachial artery is the continuation of the axillary artery in the arm. It begins at the lower border of the teres major muscle and ends in the cubital fossa by dividing into the radial and ulnar arteries. It passes down the anterior compartment of the arm and gives off branches including the profunda brachii artery. The brachial artery has important clinical significance as the brachial pulse is used to measure blood pressure and compressing it can help control hemorrhaging in the arm.
The document summarizes the major arteries of the upper limbs, including the axillary artery and its branches (thoracoacromial, lateral thoracic, circumflex humeral arteries), brachial artery and its branches (profunda brachii, ulnar collateral arteries), and the terminal branches - radial and ulnar arteries. It describes the course and branches of each artery as they supply structures in the arm, forearm, and hand.
The document summarizes the anatomy of the arteries of the forearm and hand. In the forearm, the ulnar and radial arteries are the two main arteries. The ulnar artery originates near the elbow and passes down the medial side of the forearm, while the radial artery originates from the brachial artery near the elbow and passes down the lateral side. In the hand, the ulnar and radial arteries form arches that supply blood to the digits. The superficial palmar arch is formed mainly by the ulnar artery and helps supply the palm.
The document summarizes the anatomy of the thoracic wall. It is formed posteriorly by thoracic vertebrae, laterally by ribs and intercostal spaces, and anteriorly by the sternum and costal cartilages. The intercostal spaces contain intercostal muscles and neurovascular bundles. The document further describes the layers of intercostal muscles, blood supply, innervation, and clinical procedures relevant to the thoracic wall.
The document provides an overview of the anatomy of the leg, including its bones, muscles, blood supply, innervation, and fascial compartments. It describes the tibia and fibula bones and notes the leg is divided into anterior, lateral, and posterior muscle compartments by fascia. The major muscles of each compartment and their actions are defined. The blood supply from branches of the popliteal artery and innervation from tibial and common fibular nerves are also summarized.
This document discusses principles of tendon transfers. Tendon transfers involve reattaching a functioning tendon to replace a paralyzed or injured tendon. Key points include indications such as nerve injuries or ruptured tendons. Donor tendons should match the amplitude, power, and function needed. Timing depends on factors like prognosis. Post-operative rehabilitation is important to regain motion and train new muscle functions. The goal is to restore useful hand function rather than just motion.
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.
Evidence based medicine and cosmetic surgerydrmoradisyd
This document discusses the relationship between evidence-based medicine and aesthetic plastic surgery. It provides definitions of evidence-based medicine and outlines its five primary components. The document then examines several examples of how evidence-based medicine has been applied to topics in aesthetic plastic surgery, including bariatric surgery outcomes, breast augmentation practices like antibiotic use and drain usage, and outcomes of facelifts with or without drain usage. It acknowledges that while plastic surgery literature often contains lower levels of evidence, the field should aim to both appreciate existing evidence and continue raising the overall level of evidence to best serve patients.
Carpal tunnel syndrome is caused by compression of the median nerve as it passes through the carpal tunnel. While open carpal tunnel release was previously the standard treatment, endoscopic carpal tunnel release has gained popularity as an alternative. Multiple reviews have found no difference in symptom relief between the two techniques. Evidence is conflicting on whether endoscopic surgery results in earlier return to work. Endoscopic surgery is associated with a higher risk of reversible median nerve injury but results in superior grip strength and less scar tenderness in the short term. Further research is still needed to make definitive conclusions about the relative effectiveness of open versus endoscopic carpal tunnel release.
This document discusses the anatomy and injuries of the proximal interphalangeal joint (PIPJ). The PIPJ is stabilized by articular contours, ligaments including the collateral and volar plate ligaments, and adjacent tendons. Dorsal dislocations of the PIPJ can be classified as Type I-III depending on the degree of ligament disruption and presence of fractures. Treatment depends on whether the injury is open or closed, stable or unstable, and may involve splinting, traction, pinning, open reduction and internal fixation, or tenodesis. Complications can include redisplacement, angular deformity, contractures, and stiffness.
This document discusses the physiology and process of skin grafts. It describes the layers of skin - epidermis and dermis - and their functions. It explains the classification of different types of skin grafts including full thickness and split thickness grafts. The document then outlines the four phases of "take" that a skin graft undergoes as it revascularizes and attaches to the recipient bed. It provides details on the histological and structural changes that occur in the epidermis and dermis during the healing process over subsequent days and weeks. Factors that influence graft survival and potential causes of graft failure are also summarized.
The document summarizes the anatomy of the hand, including:
1) The skin, fascia, muscles, blood vessels, and nerves of the palm and dorsum. Key structures include the thenar and hypothenar muscles innervated by the median and ulnar nerves respectively.
2) The flexor tendons in the hand pass through zones in the flexor sheath and connect to the phalanges via pulleys.
3) Extensor tendons are separated into compartments by the extensor retinaculum and pass dorsally to extend the fingers.
4) Interossei muscles abduct and adduct the fingers at the MCP and PIP joints.
The document discusses various local flap options for reconstructing fingertip injuries. It describes the anatomy of the fingertip and goals of reconstruction which are to close wounds, maximize sensation, preserve length and function. Local flap options mentioned include volar V-Y flaps, bilateral V-Y flaps, cross-finger flaps, thenar flaps and lateral island flaps. Choice of flap depends on wound orientation and configuration.
The document discusses common hand tumours such as ganglion, giant cell tumour of tendon sheath, and epidermoid inclusion cysts. It provides details on clinical presentation, investigations, classification systems, and treatment approaches for various bone and soft tissue tumours that can occur in the hand. Common malignant tumours of the hand discussed include synovial sarcoma, clear cell sarcoma, chondrosarcoma, and osteosarcoma.
This document summarizes the results of a retrospective audit assessing the financial implications of breast reconstruction procedures. It analyzed 274 patients who underwent 278 primary breast reconstructions and 366 secondary procedures between 2000-2007. DIEP flap reconstruction had the longest average length of stay but also the highest costs. Implant reconstruction had fewer secondary procedures on average but costs were still substantial due to additional procedures needed. The document concludes that while autologous reconstruction provides better long-term symmetry, the current tariff system financially discourages immediate and bilateral breast reconstruction procedures.
Squamous cell carcinoma (SCC) is the second most common skin cancer. It has a propensity to metastasize, making it responsible for most skin cancer deaths. Risk factors include UV exposure, age, immunosuppression, and primary dermatoses. Histological subtypes include pleomorphic, adenoid, small cell, verrucous, and keratoacanthoma. Tumor size greater than 2 cm and depth greater than 6 mm increase metastatic risk. Treatment involves surgical excision with adequate margins or other modalities like radiation for high risk cases.
A 48-year-old man who lost 200 kg through diet and exercise underwent a lower body lift. During the 4-hour, 2-surgeon procedure, he required repositioning 3 times and 6 drains. Post-operatively he developed hemorrhages requiring exploration. He was discharged after 8 days requiring weekly drainage of seromas. The document discusses nutritional deficiencies common after bariatric surgery that can impact wound healing for body contouring procedures. It notes diet and exercise patients have higher complication rates than those who had bariatric surgery. Careful patient evaluation and counseling is important due to the risks and limitations of massive weight loss body contouring.
This document describes the anatomy and reconstruction of the eyelids. It discusses:
1. The layers and structures of the eyelid including the skin, orbicularis oculi muscle, tarsal plates, levator palpebrae superioris muscle, and conjunctiva.
2. Embryology, blood supply, innervation, and cross section of the eyelid.
3. Specific structures like the orbital septum, tarsal plates, pre-aponeurotic fat, and lacrimal system.
4. Goals and requirements of eyelid reconstruction including reestablishing function, protection, cosmesis as well as anterior and posterior lamellae reconstruction techniques.
The document provides guidance on suturing techniques. It recommends everting the skin edges when suturing to achieve better dermal apposition, improved healing, and a finer scar. A triangular suture passage with the base located deeply is suggested to evert the wound edges, while an inverted triangular shape tends to invert them. Dermal sutures are recommended first to reduce tension before cutaneous sutures. Adjusting where the knot lies can help flatten steps between uneven wound edges. The document also reviews appropriate suture materials for different areas, recommending absorbable sutures that elicit minimal tissue reaction for the face and longer-absorbing sutures for prone areas like the back.
Annual scientific congress perth couplerdrmoradisyd
This document discusses the venous coupler as an alternative to sutures for microvascular anastomoses. It provides a brief history of vascular couplers and summarizes previous animal and clinical studies showing couplers can create anastomoses faster than sutures with similar or better patency rates. A study at Imperial College London directly compared the time and costs of using couplers versus sutures for venous anastomoses, finding couplers were significantly faster, saved over 12 minutes of ischemia time per case, and were cost effective after accounting for equipment and material costs.
This document discusses Cubital Tunnel Syndrome and Ulnar Tunnel Syndrome. Cubital Tunnel Syndrome involves compression of the ulnar nerve at the elbow, and can cause sensory changes and weakness in the hand. It is often treated initially with splinting and anti-inflammatories, and may require surgical decompression or transposition of the nerve. Ulnar Tunnel Syndrome (Guyon's canal) involves compression in the wrist and can cause numbness and weakness, sometimes from conditions like ganglions or fractures; its treatment may involve surgical release of the canal.
Flaps and grafts are used in reconstructive surgery to restore form and function. A flap maintains its blood supply, and can be skin, muscle, bone or composite tissue. Key differences between flaps and grafts are discussed. Various flap types are described based on their components, relationship to the defect, blood supply nature, and movement. Reconstructive goals include separating cavities, protecting structures, obtaining wound healing, restoring function and aesthetics. Specific flap choices are outlined for pharyngeal and mandibular defects, facial reanimation, and tongue reconstruction.
Z-plasty is a surgical technique used to close wounds where two triangular flaps based on a shared limb are transposed to close each other's defects, increasing the length of scars. The degree of elongation depends on the angle of the flaps, with greater angles providing more lengthening up to 125% for 90 degree flaps. Multiple opposing or adjacent Z-plasties can be combined for even greater lengthening effect.
Mucous cysts of the DIPJ usually occur in older adults and are associated with osteoarthritis. They contain mucin and form from degeneration of joint structures. Clinically, they appear as nodules near the DIPJ that can cause nail deformities. Treatment involves surgical excision, sometimes with additional procedures like osteophyte removal. Complications include residual deformities, stiffness, skin issues, and recurrence due to incomplete excision or persistent arthritis.
The thigh region lies between the hip and knee joints. It contains a single bone, the femur. The thigh is divided into anterior, medial, and posterior compartments by intermuscular septa. The anterior compartment contains muscles that flex the hip and extend the knee, while the posterior compartment contains muscles that extend the hip and flex the knee. The femoral triangle located in the upper anterior thigh contains the femoral nerve, artery and vein. The adductor canal on the medial thigh contains the femoral vessels and continues below as they pass into the leg. Major muscles of the thigh include the quadriceps femoris, sartorius, gracilis, and adductors.
The posterior compartment of the thigh contains the hamstring muscles - biceps femoris, semitendinosus, semimembranosus, and part of the adductor magnus. These muscles extend the thigh and flex the knee. The compartment receives blood supply from branches of the profunda femoris artery and is innervated by the sciatic nerve. The sciatic nerve terminates in the popliteal fossa, dividing into the tibial and common peroneal nerves which supply muscles in the posterior thigh.
The document describes the anatomy of the anterior thigh. It discusses the fascia lata, cutaneous nerves, and muscles in the anterior compartment, including the quadriceps femoris and sartorius. It also describes the femoral triangle and its contents, including the femoral nerve, artery, and vein.
The document describes the major arteries of the lower limb, including their origins, courses, and branches. It discusses the common iliac, external iliac, femoral, profunda femoris, popliteal, anterior tibial, posterior tibial, and peroneal arteries. Key points include that the femoral artery becomes the popliteal artery in the thigh and then divides into the anterior and posterior tibial arteries in the leg. The popliteal artery gives off muscular branches and the profunda femoris in the thigh.
The femoral triangle contains important structures in the upper thigh. It has boundaries of the inguinal ligament superiorly, the sartorius muscle laterally, and the adductor longus muscle medially. The floor contains muscles that aid in hip adduction. The femoral nerve provides sensation and motor function, and the femoral artery and vein are also located here, with the artery giving off deep branches. The structures of the femoral triangle are clinically relevant to conditions like varicose veins, hernias, and addressing muscle spasticity in cerebral palsy.
Thigh - Anterior Compartment Anatomy contains many muscles and important Triangle the Femoral triangle. This slide gives you a diagramatic representation of the Ant.Compt and also Apllied anatomy facilitating Integrated Teaching.
The main artery of the lower limb is the femoral artery. It is a continuation of the external iliac artery (terminal branch of the abdominal aorta). The external iliac becomes the femoral artery when it crosses under the inguinal ligament and enters the femoral triangle.
In the femoral triangle, the profunda femoris artery arises from the posterolateral aspect of the femoral artery. It travels posteriorly and distally, giving off three main branches:
Perforating branches – Consists of three or four arteries that perforate the adductor magnus, contributing to the supply of the muscles in the medial and posterior thigh.
Lateral femoral circumflex artery – Wraps round the anterior, lateral side of the femur, supplying some of the muscles on the lateral aspect of the thigh.
Medial femoral circumflex artery – Wraps round the posterior side of the femur, supplying its neck and head. In a fracture of the femoral neck this artery can easily be damaged, and avascular necrosis of the femur head can occur.
The document describes the major blood vessels of the lower limb. It discusses the arteries, including the femoral artery and its branches. It also discusses the veins, including the great and small saphenous veins and their tributaries. It notes the valves in the veins and their role in preventing blood flow reversal in the lower limbs.
The document describes the anatomy of the gluteal region and posterior thigh. It discusses the surface anatomy landmarks and major muscles in this region, including their origins, insertions, innervation, and actions. The gluteus maximus, medius, and minimus muscles and their roles in hip extension and abduction are summarized. Other muscles described include the pyriformis, gemelli, obturator internus, quadratus femoris, and hamstring muscles. The neurovascular structures of the gluteal region including the superior and inferior gluteal nerves and arteries are also outlined.
The document provides an anatomy overview of the lower limbs, beginning with the front of the thigh. It describes the layers of fascia in the thigh, including the superficial and deep layers. It details the structures found in the femoral triangle, including the femoral vessels, nerves, and lymph nodes. It also describes the adductor canal. The document then covers the gluteal region and hip joint before discussing the back of the thigh, knee joint, ankle joint, and the bones, muscles and vessels of the lower leg and foot.
The gluteal region contains important muscles, nerves and vessels. It is bounded by the ilium, sacrum and ischial tuberosity. The gluteal region contains nine muscles including the gluteus maximus, medius and minimus. The gluteal region receives its blood supply from the superior and inferior gluteal arteries and contains important nerves like the superior and inferior gluteal nerves. The piriformis muscle passes through the greater sciatic foramen along with blood vessels and nerves.
1. The gluteal region is supplied by cutaneous nerves from the lumbar and sacral plexuses and contains important muscles like the gluteus maximus, medius, and minimus.
2. The piriformis muscle and other structures pass through openings in the pelvis called the greater and lesser sciatic foramina.
3. The inferior and superior gluteal nerves and vessels enter the gluteal region through the greater sciatic foramen to innervate and supply blood to the muscles and skin.
The document describes the anatomy of the popliteal fossa and back of the thigh. It contains the following key points:
1. The popliteal fossa is a diamond-shaped depression on the back of the knee that contains the popliteal artery, vein and tibial nerve.
2. The hamstring muscles originate on the ischial tuberosity and insert on the tibia or fibula. They flex the knee and extend the hip.
3. The sciatic nerve arises in the pelvis and divides into the tibial and common peroneal nerves in the popliteal fossa, supplying muscles of the thigh and leg.
In human anatomy, the thigh is the area between the hip (pelvis) and the knee. Anatomically, it is part of the lower limb. The single bone in the thigh is called the femur.
The gluteal region includes the buttocks and is bounded by the iliac crest above and the fold of the buttock below. It contains thick superficial fascia containing fat and deep fascia that encloses muscles. The region receives blood supply from the superior and inferior gluteal arteries and innervation from branches of the sacral plexus including the sciatic, superior gluteal, inferior gluteal, and posterior cutaneous nerves of the thigh. The piriformis muscle separates the greater sciatic foramen into superior and inferior parts through which these structures pass into or out of the pelvis.
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.
Above power point wil give detailed explanation aboutthe cubital fossa.knowledge of this cubital fossa is clinically very important for all clinicians.
LECTURE 7MEDIAL and posterior compartment of thigh.pptmuneebrajaraja979
The medial compartment of the thigh contains the adductor muscles that adduct the thigh. The major muscles are the gracilis, adductor longus, adductor brevis, and adductor magnus. These muscles are innervated by the obturator nerve and its branch and supplied by the deep femoral and obturator arteries. The hamstring portion of the adductor magnus is innervated by the tibial nerve and flexes the knee.
The anterior abdominal wall anatomy is summarized in 3 sentences:
The anterior abdominal wall is made up of skin, subcutaneous tissue, and layers of muscle. It confines the abdominal organs and provides surgical access. The muscles are innervated by intercostal, subcostal, and ilioinguinal nerves, while the epigastric vessels supply blood.
Plastic and reconstructive surgery aims to restore form and function through surgical techniques. The key areas covered are anatomy of skin circulation via perforators, angiosomes, and vascular territories; skin physiology and function; and the reconstructive ladder of closure techniques from primary closure to grafts and flaps. Flaps maintain an intrinsic blood supply unlike skin grafts.
Carpal tunnel syndrome is caused by compression of the median nerve as it passes through the carpal tunnel. While open carpal tunnel release has traditionally been used to treat carpal tunnel syndrome, endoscopic carpal tunnel release is an alternative technique. Reviews of randomized controlled trials have found no clear difference in relief of symptoms between the two techniques. The evidence is conflicting on whether endoscopic carpal tunnel release results in earlier return to work compared to open release. Endoscopic release may provide superior short-term grip strength and less scar tenderness but risks more reversible median nerve injuries. Further research is still needed to make definitive conclusions.
Swan neck deformity is characterized by hyperextension of the proximal interphalangeal (PIP) joint and flexion of the distal interphalangeal (DIP) joint. It results from intrinsic tightness and extensor tendon imbalance caused by rheumatoid arthritis (RA). Management involves preventing further PIP hyperextension, restoring DIP extension, and addressing any underlying joint problems or soft tissue tightness based on the classification and pathophysiology. Surgical options range from splinting to tendon procedures to joint replacement depending on the severity of deformity and functional impairment.
Scaphoid fractures are the most common carpal bone fractures, often occurring in young adults from falls on an outstretched hand. The scaphoid has a tenuous blood supply and is prone to non-union, especially for proximal pole fractures. Treatment depends on fracture type and stability, ranging from casting to operative fixation with screws. Complications include malunion, delayed union, non-union and avascular necrosis, requiring further procedures like bone grafting or carpal fusion.
This document discusses tendon transfers, which involve detaching the tendon of a functioning muscle and reattaching it to replace the function of a paralyzed muscle. The key points are:
1. Tendon transfers work to correct issues like instability, imbalance, lack of coordination, and restore function.
2. They are indicated for paralyzed muscles due to nerve injury, neurological disease, or nerve repair with early transfer. They are also used for injured tendons or muscles.
3. General principles include only restoring functional hand motion, considering patient factors, ensuring the recipient site is suitable, matching the donor muscle properties, and immobilizing initially to reduce tension.
The radial nerve originates from cervical and thoracic nerve roots and is the largest branch of the brachial plexus. It provides cutaneous innervation to the posterior arm and forearm and motor innervation to triceps, brachioradialis, and extensor muscles of the forearm and hand. The radial nerve is vulnerable to compression at the radial tunnel as it travels through the forearm. Compression can cause radial tunnel syndrome. The superficial branch of the radial nerve can be affected by Wartenberg syndrome. Radial nerve palsy can result from fractures, injuries, tumors, or iatrogenic causes.
Perineal reconstruction after pelvic surgery aims to restore form and function through flap reconstruction. The VRAM flap provides reliable vascularity, bulk, and a large skin paddle, making it the first choice for reconstruction. A study found VRAM flaps had significantly fewer complications than thigh flaps for perineal defects. Other flap options include the gracilis, posterior thigh, and perforator flaps from the gluteal arteries. Proper postoperative care is needed to ensure flap survival.
The document discusses the anatomy and tumours of the parotid gland. It describes the location and lobes of the parotid gland, its blood supply and innervation. It then discusses the various types of tumours that can occur in the parotid gland and other salivary glands, including pleomorphic adenoma, Warthin's tumour, mucoepidermoid carcinoma, adenoid cystic carcinoma, and metastatic carcinomas. It provides details on the histology, presentation and characteristics of these tumour types.
Orbital fractures involve breaks in the bones surrounding the eye socket. The orbital anatomy consists of 7 bones that form the pyramid-shaped orbit. Common types of orbital fractures include fractures of the orbital floor, medial wall, and lateral wall. Signs and symptoms vary depending on the structures involved but may include diplopia, limited eye movement, numbness, and vision changes. Evaluation involves history, exam of cranial nerves and eye movement, and CT scan. Treatment depends on findings but may involve initial management with ice and antibiotics followed by surgery to repair the fracture if indicated to address issues like diplopia or enophthalmos. Surgical approaches and potential complications are discussed.
Flaps and grafts are used in reconstructive surgery to restore form and function. A flap maintains its blood supply, while a graft does not. There are several types of flaps characterized by their tissue components and blood supply. Free flaps use tissue transferred without a pedicle, while pedicled flaps maintain an attachment. Reconstructive procedures aim to separate cavities, restore function, and provide aesthetically pleasing results with minimal complications. Specific flap choices are tailored to the goals and defects in pharyngeal, mandibular, facial, and tongue reconstruction.
Hand infections were a major cause of disability before antibiotics. Kanavel defined hand anatomy and drainage techniques. Penicillin reduced severe infections. Antibiotics alone rarely cure infections beyond 48 hours due to vessel thrombosis and pressure in closed spaces. Felons and paronychia each account for 1/3 of hand infections and usually result from minor trauma introducing Staph aureus. Flexor tenosynovitis is a surgical emergency to prevent tendon damage. Deep space infections involve the palmar, dorsal, thenar and midpalmar spaces and spread if not drained properly.
1. The authors present their 10-year experience with 43 jejunal free flaps for reconstruction following pharyngolaryngectomy.
2. They report a 100% acute flap survival rate and an overall benign fistula rate of 4.7%. No fistulas occurred in patients who received a prophylactic pectoralis major muscle flap after radiotherapy.
3. Using a gastrointestinal stapler for the proximal and distal anastomoses was associated with a lower fistula rate compared to hand-sewn anastomoses.
This document discusses flexor tendon zones, tenosynovitis (infection of the flexor tendon sheath), and its diagnosis and treatment. Tenosynovitis most often results from penetrating trauma near joint creases. It causes purulence and adhesions within the sheath, destroying gliding and blood supply. Key signs are tenderness over the sheath, swelling of the digit, and pain with passive extension. Early cases may be treated with antibiotics but established infections require prompt surgical drainage to prevent tendon and skin necrosis.
This document discusses different methods of classifying flaps used in reconstructive surgery. It describes classification based on composition, proximity to the defect, method of movement, and vascular anatomy. Specific types of flaps are also outlined including local, regional, distant, and free flaps as well as fascio/cutaneous and musculocutaneous flaps. Arterial supply, types of movement including advancement, transposition, and rotation are summarized.
Akademikliniken (AK) is a plastic surgery clinic in Stockholm with two centers and over 100 employees. They offer a 1-year unpaid fellowship that provides housing and meals. Starting this year, the fellowship will be formalized into a paid 1-year program. The fellow would assist with over 4,500 operations per year, primarily aesthetic procedures. In Moradi's 4.5 month fellowship, he assisted with over 300 cases across facial aesthetics, breast procedures, body contouring surgeries, and free flaps. The clinic also hosts monthly masterclasses and social events for fellows and surgeons.
This document discusses reconstructive options for fingertip injuries. The goals of reconstruction are to close wounds, maximize sensory return, preserve length and joint function, and obtain a cosmetic appearance. Options include healing by secondary intention, skin grafting, and local flap reconstruction using flaps such as volar V-Y flaps, bilateral V-Y flaps, cross-finger flaps, and thenar flaps. Major complications are hypersensitivity and cold intolerance, which usually resolve after 1-2 years.
This document describes the anatomy and reconstruction of the eyelids. It discusses:
1. The layers and structures of the eyelid including the skin, orbicularis oculi muscle, tarsal plates, levator palpebrae superioris muscle, and conjunctiva.
2. Embryology, blood supply, innervation, and cross section of the eyelid.
3. Specific structures like the orbital septum, tarsal plates, pre-aponeurotic fat, and lacrimal system.
4. Goals and requirements of eyelid reconstruction including reestablishing function, protection, cosmesis as well as anterior and posterior lamellae reconstruction techniques.
6. Anteromedial thigh flap
► Femoral artery lies in subsartorial canal for its lower 2/3, and in this
portion gives off muscular and fasciocutaneous branches
Perforators pass around both borders of sartorius to form a plexus at the level
of the deep fascia with an axis along the border of sartorius
Range in size from 0.5-1mm Ø
80% cases the largest perforator passes around the superomedial border of
sartorius in the apex of the femoral triangle
► Additionally also supplies muscle, so it’s diameter is 0.5-1.2mm
► Accompanied by a vein
► Supplies an area of 7x12cm on anteromedial thigh, with upper part of ellipse
overlying the apex of the femoral triangle
► Area is supplied by the medial anterior cutaneous nerve of the thigh
Crosses medially in front of artery at the apex of the femoral triangle
Can be raised as an innervated flap
► Type B fasciocutaneous flap
Raised by identifying perforator first, the adjusting the flap position to be
centred over the artery
7.
8. Saphenous flap
► Saphenous artery is one of three terminal branches of descending genicular branch of femoral
artery
Given off from medial side of femoral artery immediately before if enters the adductor hiatus
Runs under sartorius and sends cutaneous branches anterior and posterior to muscle
Runs under insertion of tendon to emerge posteriorly and continue in lower leg, usually only for about
12cm
► 1.5-2mmØ, paired vc’s + GSV
► Safe dimensions are 6x20cm, allowing primary closure of defect
► Raised proximal to distal to visualise vessels and their relationship to tendon first
► Can raise distally based flap, useful in stump wound breakdown
11. Tensor Fascia Latae
►Origin – ASIS + iliac crest
►Insertion – Lateral condyle of tibia via fascia lata
►Innervation – Superior gluteal nerve (L4,5)
►Action – Abducts, medially rotates and flexes thigh.
Hip stabiliser and assists in keeping knee extended
►Type I muscle
Branch off ascending branch of lateral circumflex femoral
artery
Single artery 2-3mm diameter, paired venae comitantes
Enters muscle on deep surface 9cm below ASIS
12.
13. Rectus femoris
► Type II bipennate muscle supplied primarily by LCFA
► Origin: AIIS and deep/reflected part from superior acetabular rim
► Insertion: Tibial tuberosity via superior part of patella, separated from femur by
suprapatellar bursa. Deepest layer of quadriceps tendon
► Innervation: Br of Femoral nerve (L3,4), deep group, usually double
Upper branch gives a proprioceptive branch to hip (Hiltons law)
► Action: Extend knee, stabilise hip joint and assists iliopsoas flex hip
► Reliable vascular pedicle and considerable length (7x40cm)
Pedicle generally arises 5cm below top of symphysis pubis and runs downwards for 5-8cm before
piercing the muscle on posteromedial border at junction of proximal and middle thirds
Divides into superior and inferior branches
► Rotation point is 7cm below inguinal ligament
► Muscle is necessary for fully functional knee extension, so is not expendable except in spinal
patients (when gracilis or TFL can be used)
► Skin paddle is based over lower 2/3 of muscle
► Skin paddle sensation is supplied by intermediate anterior cutaneous nerve of thigh
14.
15. Vastus lateralis
► Type II muscle with dominant proximal pedicle from LCFA augmented by multiple
perforators from the posterior compartment
► Origin: Greater trochanter, lateral lip of linea aspera of femur
► Insertion: Tibial tuberosity via patella. Middle layer of quadriceps tendon
► Innervation: Br of femoral nerve (L2,3,4), deep group
► Action: Extends knee
► Descending br LCFA runs down behind anterior edge of VL with nerve supply and
terminates in muscle in 90%, skin in 10%
► As branches enter the muscle, multiple neurovascular hila are formed. One into
proximal third, three in proximal and middle third
60% cases, branches pierce deep fascia over anterior part of muscle and supply skin
40% cases septocutaneous perforators given off in intermuscular septum to reach deep
fascia (see ALT flap)
► Main use is in repair of trochanteric pressure sores and salvage of hip wound
Can be raised as a free flap
► Raised as from an incision slightly lateral to a line from ASIS to superolateral
aspect of patella
16.
17. Anterolateral thigh flap
► Type B fasciocutaneous flap
► Supplied by descending branch of lateral circumflex femoral artery, usually
associated with 2 vc’s
Length 8 – 16cm, diameter 2-3mm
► Pedicle transverses obliquely in groove between rectus femoris and vastus
lateralis along with nerve to vastus lateralis
► Cutaneous perforators usually found in inferolateral quadrant of 3cm circle
with centre at midpoint ASIS to superolateral corner of patella
Can be septocutaneous or musculocutaneous perforators
Can be raised as super thin, fasciocutaneous or musculocutaneous flap
► Maximum dimensions 12x8cm, with most distal part of flap at least 4cm
above proximal end of patella
► Can incorporate anterior branch of lateral cutaneous nerve of thigh to create
sensory flap
20. Gracilis
► Origin – inferior pubic ramus, just below fascia lata
► Insertion – subcutaneous surface of tibia, just behind sartorius
► Innervation – obturator nerve
Single nerve with multiple fascicles to different portions of muscle (so useful
in facial reanimation)
► Action – adduct thigh, flexes leg, assists medial rotation
► Type II muscle
Adductor branch of profunda femoris or descending branch of MCFA
Main pedicle 1-2mm diameter, paired vc’s
One or to minor pedicles from superficial femoral artery enter muscle distally
Pedicle courses from medial to lateral, and enters the deep surface about
10cm inferior to pubic tubercle (junction of upper 1/3 and lower 2/3) – pivot
point
► Usually used as muscle only flap, but can be used as musculocutaneous
flap with skin island over superior half of muscle
21.
22. Hamstring flaps
► Hamstring musculocutaneous flaps
were developed for treatment of
ischial pressure sores, but can be
transposed to anterior thigh
► VY musculocutaneous unit
advancements have the advantage of
being able to be re-elevated and
advanced should pressure sores recur
► Can be raised on all 4 hamstring
components or only biceps or
semitendinosis
► Can be constructed to maintain
innervation via posterior cutaneous
nerve of thigh
► Large skin islands up to 12x35cm
extending past the muscle borders can
be raised
23. ► Biceps femoris ► Semitendinosis
Origin: Long head from ischial Origin: Ischial tuberosity
tuberosity, short head from linea Insertion: Medial surface of
aspera of lateral supracondylar line superior part of tibia, just below
of femur gracilis
Insertion: Lateral side of head of Innervation: Tibial part of sciatic
fibula. Tendon is split by fibular nerve (L5-S2)
collateral ligament of knee Action: Extend thigh, flex leg and
Innervation: Long head is tibial rotate medially, extend trunk
division of sciatic nerve (L5-S2), when thigh and leg are flexed
short head is common peroneal Arterial supply: Type II. Primary
branch of sciatic nerve (L5-S2) dominant pedicle from first
Action: Flex leg and rotate profunda perforator and smaller
laterally, extends thigh pedicle superior to this from
Arterial supply: Type II. Major MCFA. Also small branches from
branches from the first profunda inferior gluteal to origin, and
perforator at upper third junction. inferior medial genicular to
Branches from second perforator insertion
to lower part of long head and to
short head. No anastomoses
between short and long head.
Further minor supply from inferior
gluteal artery, MCFA, sup lat
genicular artery
24.
25. Lateral thigh flaps
► Lateral thigh flaps are based on the perforators from profunda femoris, each of which
terminates by dividing into two branches at the point of the insertion of the lateral
intermuscular septum into the femur (deep to origin of short head of biceps femoris)
► One of these branches pierces lateral intermuscular septum to supply vastus lateralis, the
other runs on posterior aspect of intermuscular septum towards the iliotibial tract
► Consistent large perforator from 1st profunda perforator within 3cm of lower border of
gluteus maximus (may be through the muscle), often the largest of the perforators
Can raise skin flaps of up to 8x25cm, usually pedicled (superior lateral thigh flap) due to the
relationship to gluteus insertion
► Also branch from 3rd profunda perforator (ED 1-1.5mm) at midpoint between greater
trochanter and lateral femoral condyle (middle thigh flap)
Usually raised as a free flap due to long pedicle length
Raised without deep fascia, so small area but thin and can be innervated
As most perforators run anteriorly, best to plan this flap with only 1/3 – ¼ behind lateral
intermuscular septum
► Venous drainage is by paired vc’s of the cutaneous perforators that tend to join as they
approach the femur
► Nerve supply of the area is the lateral femoral cutaneous nerve
Emerges from beneath lateral end of inguinal ligament and divides into 2 branches that run down
the iliotibial tract
28. Gastrocnemius
►Origin
Medial head – Popliteal surface of femur, superior
to medial condyle
Lateral head – Lateral aspect of lateral condyle of
femur
►Insertion – Posterior surface of calcaneus via
tendocalcaneus (Achilles tendon)
►Innervation –Tibial nerve (S1,2)
►Action – Plantarflexes ankle, raises heel
during walking, flexes knee joint
29. ►Mathes + Nahai Type I for each head
Each head supplied by a sural artery, which arises from
popliteal artery at or slightly above the joint line and is 2-5cm
long
►Occasionally arises from common trunk, or lateral sural arises with
inferior lateral or middle genicular artery
►Artery to medial head run directly to muscle
►Artery to lateral head passes anterior to popliteal vein and tibial
nerve, may give off branches to plantaris and soleus as well as a small
vessel accompanying surely nerve
3mm diameter with paired vc’s, one of which can be up to
4mm diameter
Enters each head at level of tibial condyles (pivot point), with
nerves posterior to artery in 90% cases
Within the muscles each sural artery divides into two
branches which run longitudinally between muscle fibre
bundles and often subdivide further
►Medial head can reach to lower third femur, whereas
lateral head has a smaller arc of rotation
30.
31. Soleus
►Origin – Inferior end of lateral supracondylar
line of femur and oblique popliteal ligament
►Insertion – Posterior surface of calcaneus via
tendocalcaneus (Achilles tendon)
►Innervation –Tibial nerve (S1,2)
►Action – Plantarflexes ankle and steadies leg
on foot
32. ►Mathes + Nahai Type II muscle
Dominant proximal supply from popliteal artery
branches and a secondary distal supply from
branches of posterior tibial artery
Reverse flap has been described to cover heel
defects, but it’s reliability is questionable
►Used to cover middle third tibial defects
►Bipennate muscle, so can be split into larger
medial flap and a smaller lateral hemisoleus flap
33. Popliteo-posterior thigh flap
► Inconstant vessel from proximal part of
popliteal artery, so Doppler assessment is
important
► Generally reaches deep fascia 8-10cm
above plane of knee with paired vc’s and
ascends in midline
May anastomose with br of inferior gluteal
artery that accompanies the posterior
cutaneous nerve of the thigh
► Can raise flap as high as gluteal crease, and
defect can be primarily closed if width <
10cm
► Arc of rotation allows coverage of patella,
calf and sides of upper quarter of leg
► Elevation begins inferiorly, taking skin and
deep fascia and septum between biceps
femoris and semitendinosis
34. Lateral genicular flap
►Islanded flap based on cutaneous
termination of superior lateral
genicular artery, but may have
some supply from inferior
anastomotic (or Bourgery’s)
artery
►Emerge along fascial septum, and
then fan out above the iliotibial
tract
►Unnecessary to raise iliotibial
tract unless it is required in part
of the reconstruction
35. Lower lateral thigh flap
► Essentially a lateral genicular flap with
a broad pedicle overlying the lateral
intermuscular septum that may
incorporate the 4th PFPA
► Can raise flap up to 25cm long if at
least two vessels, but 20cm vertically
by 10cm horizontally is considered
safe
► Raised leaving thin layer of loose
areolar tissue over iliotibial tract to
allow successful skin grafting
► Exposure and mobilisation of pedicle
if required necessitates division of
vastus lateralis and short head of
biceps
36. (Lower) Posterolateral thigh flap
►Lower lateral thigh flap
raised with a broad
pedicle to include the
vertical midline branch
of the popliteal artery
38. Calf fasciocutaneous
► Commonly raised on perforators
from posterior tibial arteries
Emerge from between soleus and
FDL
5-6 perforators given off, tend to
be larger proximally
Branch on reaching deep fascia
which spread anteroposteriorly
and slightly inferiorly
► Can also be raised off peroneal
artery from posterior peroneal
septum
► Important to raise flaps with
fascia. Generally only 3:1 . Can
be distally based and/or
islanded
39. Neurofasciocutaneous flaps
► Sural or saphenous nerves
► Rely on vasanervorum and vasovasorum
for supply of a distally based flap
► Skin island marked along axis of sural
nerve and small saphenous vein, with
rotation point 5-7cm above lateral
malleolus
► Can raise up to 10x13cm flap with delay
procedures
► Allows flap coverage without sacrificing
major vessels
► Flap raised with deep fascia and SSV with
subcutaneous pedicle 4cm wide. Medial
sural nerve left intact
► Can be made sensate by inclusion of lateral
sural nerve and retrograde dissection of
adequate stalk length
► Useful in heel and Achilles tendon
coverage
40. Fibular osteocutaneous flap
► Type C osteofasciocutaneous flap
► Nutrient vessel to the fibula is given off about 7cm from the origin of the
artery and penetrates the bone on the posterior or medial surface, posterior
to interosseous membrane
► Nutrient foramen lies in middle third of bone on average 17cm from styloid
process of fibula
► Cutaneous perforators pass along the posterior peroneal septum to reach
the skin
► Can run through part of FHL +/- soleus, so most surgeons take a cuff of
muscle posterior to septum in raising the flap
► Largest perforators lie between 10 and 20cm below the head of the fibula
► Skin ellipse marked so that 1/3 is anterior to septum, 2/3 behind (max
dimensions are 5cm anterior, 10cm posterior), centered on 10-20cm below
fibular head
► Posterior edge dissected first, then anterior, the bone mobilised
► Distal 5cm of fibula should be left to maintain the ankle mortise
► Can raise free fibula with epiphysis
41.
42.
43. Supramalleolar flap
► Distally based flap raised on anterior perforating branch of
peroneal artery
Pierces intermuscular septum about 5cm above lateral malleolus and
divides into deep br and superficial cutaneous br
SCB emerges between EDL and peroneus brevis and directs branches
proximally to supply an area of 8x16cm
► Planned around pivot point as described above, with lateral
border no further posterior than line of fibula
► Adequate rotation may require a back cut in the line of the 5th
toe
► Flap raised from anteromedial edge, preserving the
superficial peroneal nerve, then down to deep fascia
44.
45. Lateral calcaneal flap
►Based on the calcaneal branches of the peroneal
artery in the foot
►Follows peroneus longus tendon about 1cm
posterior to it, 5-8mm anterior to Achilles tendon at
the ankle down to 3cm inferior to tip of fibula before
continuing to tuberosity of 5th metatarsal before
anastomosing with lateral plantar artery
►Venous drainage of the area is via the lesser
saphenous vein, and innervation by sural nerve (lies
anterior to SSV)
►Can be raised islanded or reverse flow
46.
47. Dorsalis pedis
► Cutaneous supply of DP proper is a strip 2-3cm wide from extensor retinaculum to
half way along interosseous space
Distal to this is supplied by 1st dorsal metatarsal artery, which lies beneath EHL tendon,
and can have a deep origin in up to 20% cases
Lateral to this area is supplied by the lateral tarsal and arcuate arteries, which cannot be
included in the flap as they are deep to EDB and the long extensor tendons
So usual flap plan relies on subcutaneous anastomoses between these supplies
Distal end is prone to necrosis, so delay procedures are common
► Planned with proximal end of flap at inferior extensor retinaculum, distal end is
proximal to web spaces, lateral extent is the borders of the foot
► Paired vc’s accompany the dorsalis pedis
► Innervation of the area is by the superficial peroneal nerve, with 2PD ≈ 15mm
► Plane of elevation must leave enough paratenon for split skin graft take
► Transposition flaps utilising just the skin supplied by the 1 st dorsal metatarsal artery
are useful in managing foot scars and local tissue loss, and reverse flow dorsalis
pedis flaps can be used in managing midfoot amputation stumps
48.
49.
50. Lateral plantar
► Posterior tibial artery consistently divides into medial and lateral plantar
branches at about the posterior edge of the sustentaculum tali
► LPA gives off several calcaneal branches that pierce FDB and plantar
aponeurosis near the attachment to medial tubercle of calcaneus before
running distally between FDB and flexor accessorius until lateral border of
plantar aponeurosis
► The LPA supplies lateral border of 5th toe and curves medially to form the
deep plantar arch
► Sensory innervation of the sole is by lateral plantar nerve in the lateral
third and by medial plantar nerve in the medial two thirds
► This supply allows rotation/advancement flaps of the calcaneal branches
or the entire lateral part of the sole to cover heel defects (FDB
musculocutaneous flap)
Has also been raised retrograde to cover 4 th + 5th metatarsal heads
51.
52. Medial plantar
► MPA runs between abductor hallucis and FDB, and sends cutaneous supply to
medial sole via perforators that pass superior and (mainly) inferior to abductor
hallucis
► Medial sole is innervated by medial plantar nerve (tibial nerve usually divides
proximal to the posterior tibial artery, and the nerve usually runs medial to the
artery)
► Venous drainage of the area is via the GSV and paired vc’s that accompany the
MPA
► The flap is planned to avoid weight bearing areas and not to extend above the
tuberosity of the navicular bone
Lateral edge of abductor hallucis is the axis along which cutaneous perforators emerge,
and so the flap axis (surface marking is centre of heel to the medial sesamoid of the
great toe, or the medial edge of the plantar aponeurosis)
Proximal incision to the sustentaculum tali may be required for dissection of the pedicle
Flaps can be raised up to 10cm long x 7cm wide
► Flaps can be raised proximally or distally based, and in combination with lateral
plantar artery
53.
54. Toe flaps
►Multiple options based on plantar digital
arteries and nerves
Complete toe transfer (or paired toe transfer)
Pulp transfer (+/- nail bed)
Homodigital neurovascular island flap
Composite PIP or MCP joint