Summer AnatomyFlaps

TFL and Rectus FemorusReid ChambersJuly 19, 2012

Local Vascular Anatomy

Tensor Fascia LataMuscle 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

Anatomy

• Origin/Insertion – ASIS/iliotibial tract to lateral condyle of tibia

• Artery – Ascending branch of LCFA (1.5-2.5mm) up to 10cm pedicle

• Venous – Vena comitantes

• Innervation – LFCN – sensory, Distal SGN -motor

Variations

• Muscle, fascial, myofascialcutaneous

• Chimeric Flap with ALT +/- rectus femoris

• Can include outer table of iliac crest

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

third

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

Rectus Femoris

• Class – Type II

• Uses– Local – inferior abdo, groin, perimeum, ischium

– Free – Adbo wall, Facial reanimation (more historical as too bulky)

Anatomy

• Origin/Insertion-AIIS+acetabulum/Patella

• Artery – Decending LCFA 5cm pedicle, 2mm

• Venous – venae comitantes

• Inervation – sensory ant. Fem. Cutaneous. Motor – femoral nerve branch

Variations

• Myocutaneous – overlying skin paddle in midanterior 2/3rds of thigh up to 12x20cm

• Functional Muscle Flap

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

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