Presentation is loading. Please wait.

Presentation is loading. Please wait.

Tensor Fascia Lata, Rectus Femoris, Gracilis Flaps Ian Maxwell.

Similar presentations


Presentation on theme: "Tensor Fascia Lata, Rectus Femoris, Gracilis Flaps Ian Maxwell."— Presentation transcript:

1 Tensor Fascia Lata, Rectus Femoris, Gracilis Flaps Ian Maxwell

2 Tensor Fascia Lata

3 Overview Classification: Mathes and Nahai type I muscle flap Pedicle length: up to 10cm Pedicle calibre: mm (artery) Uses – Groin – Ischium – Perineum – Lower abdomen – Sacrum – Trochanter

4 Anatomy Origin: – anterior iliac crest Insertion: – illiotibial tract Blood supply: – ascending branch of the lateral circumflex femoral artery Innervation: – Sensory: lateral cutaneous sensory nerve of the thigh – Motor: distal branch of the superior gluteal nerve

5

6 Variations Bone (ASIS) +/- TFL muscle Neurosensory – Include lateral sensory branch of T12 or lateral femoral cutaneous nerve Expanded or transverse skin paddle Perforator flap V-Y advancement

7 Surgical Markings Mark a line from ASIS to the lateral patella (anterior axis) Pedicle is located anywhere from 8-12 cm below ASIS Axis of femur marks posterior aspect of flap

8 Dissection Elevate flap from distal to proximal More proximally, retractor placed between rectus femoris and vastus lateralis – First identify descending branch of LFCA, then identify ascending branch more superiorly Isolate pedicle course to TFL Pedicle can be traced to lateral femoral circumflex vessels/profundus to gain calibre and length

9 Cases:

10

11

12 Rectus Femoris

13 Overview Reliable blood supply and motor innervation Classification: Mathes and Nahai type 2 (dominant and minor arterial supply) Major disadvantages are: – Not a particularly expendable muscle – Pedicle can be affected by atherosclerosis Coverage of lower abdomen, groin, ischium, trochanteric region, functional muscle transplantation

14 Anatomy Origin: iliac portion of acetabulum and ASIS Insertion: patella Arterial supply: – Dominant = descending branch of lateral femoral circumflex artery – Minor = ascending branch of lateral femoral circumflex artery and muscular branch of SFA Vein = venae commitantes Pedicle length/calibre = 5cm/2mm Nerve = motor branch from femoral nerve

15 Variations With or without skin paddle – Most perforators within middle third of thigh Innervated functional muscle

16 Surgical Markings Draw line from ASIS to mid patella for longitudinal axis Lazy S incision over muscle Pedicle just proximal to junction of proximal and middle thirds of thigh (8-10 cm below AIIS) Length limited to middle 1/3 rd of thigh

17 Flap dissection Incise through skin paddle (if required) Through muscular fascia Sartorius and rectus femoris identified Sartorius retracted medially Lateral femoral circ vessels lie here on proximal portion of muscle Pedicle is 8-10cm below AIIS Muscle freed from medial, lateral, distal fascial attachments Raised on pedicle

18

19 Gracilis

20 Overview Workhorse flap Used for pedicled coverage of groin, vaginal/groin reconstruction Used as free innervated functional muscle for facial reanimation – Segmental motor nerve supply allows muscle to be sectioned (3 branches: anterior, mid, posterior) Mathes and nahai type 2 muscle flap Pedicle length/calibre = 6cm/1-2mm

21

22 Anatomy Origin = pubic ramus Insertion = pes anserinus Arterial supply – Dominant = terminal branch of MFCA – Minor = branches of SFA and PFA Venous drainage = venae commitantes Nerve – motor = anterior branch of obturator nerve Enters 1-2 cm superior to vascular pedicle – Sensory = medial cutaneous nerve of thigh

23

24 Flap variations: Can harvest with skin paddle (i.e. TUG flap) – Common second choice for breast FTT +/- innervated

25 Skin markings Axis of flap is line from ischium to medial condyle of knee Or palpate adductor longus: gracillis is 2-3 finger breadths posterior pedicle marked 10cm below ischium

26

27 Flap dissection Incise over axis of muscle proximally Optional distal incision to disinsert distal insertion Dissect down to fascia over gracillis and adductor longus until septum reached Retract these muscles apart from each other – Pedicle lies here Proximal origin divided, pedicle dissected

28

29


Download ppt "Tensor Fascia Lata, Rectus Femoris, Gracilis Flaps Ian Maxwell."

Similar presentations


Ads by Google