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

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

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

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

Summer AnatomyFlaps

TFL and Rectus FemorusReid ChambersJuly 19, 2012

Page 2: Summer Anatomy Flaps TFL and Rectus Femorus Reid Chambers July 19, 2012.

Local Vascular Anatomy

Page 3: Summer Anatomy Flaps TFL and Rectus Femorus Reid Chambers July 19, 2012.

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

Page 4: Summer Anatomy Flaps TFL and Rectus Femorus Reid Chambers July 19, 2012.

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

Page 5: Summer Anatomy Flaps TFL and Rectus Femorus Reid Chambers July 19, 2012.

Variations

• Muscle, fascial, myofascialcutaneous

• Chimeric Flap with ALT +/- rectus femoris

• Can include outer table of iliac crest

Page 6: Summer Anatomy Flaps TFL and Rectus Femorus Reid Chambers July 19, 2012.

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

third

Page 7: Summer Anatomy Flaps TFL and Rectus Femorus Reid Chambers July 19, 2012.

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

Page 8: Summer Anatomy Flaps TFL and Rectus Femorus Reid Chambers July 19, 2012.

Rectus Femoris

• Class – Type II

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

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

Page 9: Summer Anatomy Flaps TFL and Rectus Femorus Reid Chambers July 19, 2012.

Anatomy

• Origin/Insertion-AIIS+acetabulum/Patella

• Artery – Decending LCFA 5cm pedicle, 2mm

• Venous – venae comitantes

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

Page 10: Summer Anatomy Flaps TFL and Rectus Femorus Reid Chambers July 19, 2012.

Variations

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

• Functional Muscle Flap

Page 11: Summer Anatomy Flaps TFL and Rectus Femorus Reid Chambers July 19, 2012.

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

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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