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Summer Anatomy Flaps TFL and Rectus Femorus Reid Chambers July 19, 2012.

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Presentation on theme: "Summer Anatomy Flaps TFL and Rectus Femorus Reid Chambers July 19, 2012."— Presentation transcript:

1 Summer Anatomy Flaps TFL and Rectus Femorus Reid Chambers July 19, 2012

2 Local Vascular Anatomy

3 Tensor Fascia Lata Muscle and Fascia Flap Class – Type 1 muscle flap Uses – Local – groin/perineum, abdo, trochanter, ischium, sacrum, vulva – Free – Breast, H+N, extremties, abdo* *thickness of the fascia lata over the TFL muscle provides a strong fascial donor site for recon of the adbo wall

4 Anatomy Origin/Insertion – ASIS/iliotibial tract to lateral condyle of tibia Artery – Ascending branch of LCFA ( mm) up to 10cm pedicle Venous – Vena comitantes Innervation – LFCN – sensory, Distal SGN -motor

5 Variations Muscle, fascial, myofascialcutaneous Chimeric Flap with ALT +/- rectus femoris Can include outer table of iliac crest

6 Landmarks Anterior limit - Line from ASIS to lateral patella Post limit – axis of femur Pedical enters flap at juntion of prox/middle third

7 Elevation From distal to proximal in sub fascial or sub muscular Identify descending branch of LFCA between vastus lat and rectus – follow this back to isolate the pedicle Dissect out proximal portion Primary closure can lead to compartment syndrome if too large a flap is taken

8 Rectus Femoris Class – Type II Uses – Local – inferior abdo, groin, perimeum, ischium – Free – Adbo wall, Facial reanimation (more historical as too bulky)

9 Anatomy Origin/Insertion-AIIS+acetabulum/Patella Artery – Decending LCFA 5cm pedicle, 2mm Venous – venae comitantes Inervation – sensory ant. Fem. Cutaneous. Motor – femoral nerve branch

10 Variations Myocutaneous – overlying skin paddle in midanterior 2/3rds of thigh up to 12x20cm Functional Muscle Flap

11 Elevation A line is drawn from ASIS to midanterior patella Distal identification of muscle bellies/tendons of vastus med/lat and tendionous rectus insertion – this is divided prox to patella Elevate in prox direction to prox 1/3 of thigh Pedicle is identified approx 8-10cm below AIIS Dissect laterally off TFL to level of AIIS Trace back pedicle to required length – for free flap divide muscle proximally and dissect back to LCFA

12 Issues Distal skin island is unreliable as this area is predominantly tendinous Functional loss of terminal leg extension May not be viable in patients with PVD

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