1887

Pedicled muscle flaps

image of Pedicled muscle flaps
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Abstract

Local transposition of a muscle flap is a useful and simple technique and does not require any special instrumentation. However, it does require a good knowledge of anatomy, an understanding of the indications and limitations of the technique, and careful dissection. A muscle flap is indicated when the specific benefits of transposed muscle tissue are needed. This is particularly the case when closing defects that are ischaemic, infected or irradiated, or when muscle bulk or physical support is needed. This chapter discusses Indications; Types of muscle flap; Using muscle flaps; Complications; and Myocutaneous flaps. : Repair of a perineal hernia hernia with a semitendinosus muscle flap; and Reconstruction of a thoracic wall deficit (following tumour resection) with a latissimus dorsi myocutaneous flap. : Raising a muscle or myocutaneous flap; Humeral head of the flexor carpi ulnaris muscle flap; Ulnaris lateralis muscle flap; Superficial gluteal muscle flap; Internal obturator muscle flap; Cranial sartorius muscle flap; Caudal sartorius muscle flap; Rectus femoris muscle flap; Semitendinous muscle flap; Cranial border of the lateral head of the gastrocnemius muscle flap; Cranial tibial muscle flap; Temporalis muscle flap; Cranial portions of the sternocephalicus, sternothyroideus and sternohyoideus muscle flaps; Caudal portions of the sternocephalicus, sternothyroideus and sternohyoideus muscle flaps; Cervical portion of the trapezius muscle flap; Deep pectoral muscle flap; Latissimus dorsi muscle flap; Cranial portion of the external abdominal oblique muscle flap; Rectus abdominis muscle flap; Cutaneous trunci myocutaneous; Latissmus dorsi myocutaneous flap; Trapezius myocutaneous flap; and the Gracilis myocutaneous flap.

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Figures

Image of 9.3
9.3 Typical vascular supply to a skeletal muscle. Note that it is composed of a combination of large and small pedicles, and the pedicle systems often share small anastomotic channels at their borders. Drawn by S.J. Elmhurst BA Hons (www.livingart.org.uk) and reproduced with her permission.
Image of 9.4
9.4 The probable consequence of basing muscle flap perfusion on a minor pedicle system. The volume of blood that can be forced through and returned via anastomotic channels is insufficient, and a large portion of muscle becomes severely ischaemic, if not necrotic. Drawn by S.J. Elmhurst BA Hons (www.livingart.org.uk) and reproduced with her permission.
Image of 9.5
9.5 Perfusion of a muscle will be sustained throughout after ligation of minor pedicles because the remaining dominant pedicle is sufficiently large to maintain arterial and venous flow. Drawn by S.J. Elmhurst BA Hons (www.livingart.org.uk) and reproduced with her permission.
Image of 9.6
9.6 Patterns of vascular anatomy of skeletal muscles. Drawn by S.J. Elmhurst BA Hons (www.livingart.org.uk) and reproduced with her permission.
Image of Incision.
Incision. Incision.
Image of Semitendinosus muscle exposed.
Semitendinosus muscle exposed. Semitendinosus muscle exposed.
Image of Muscle elevated.
Muscle elevated. Muscle elevated.
Image of Muscle flap dissected free and reflected to show vascular pedicle.
Muscle flap dissected free and reflected to show vascular pedicle. Muscle flap dissected free and reflected to show vascular pedicle.
Image of Muscle flap transposed.
Muscle flap transposed. Muscle flap transposed.
Image of Wound closed. There is a prolapsed rectum.
Wound closed. There is a prolapsed rectum. Wound closed. There is a prolapsed rectum.
Image of Imaging studies of the thoracic mass.
Imaging studies of the thoracic mass. Imaging studies of the thoracic mass.
Image of Anatomical landmarks and flap margins outlined.
Anatomical landmarks and flap margins outlined. Anatomical landmarks and flap margins outlined.
Image of Tumour resection.
Tumour resection. Tumour resection.
Image of There is insufficient local skin to close the defect.
There is insufficient local skin to close the defect. There is insufficient local skin to close the defect.
Image of Latissimus dorsi myocutaneous flap raised and transposed.
Latissimus dorsi myocutaneous flap raised and transposed. Latissimus dorsi myocutaneous flap raised and transposed.
Image of Wound closed and drain in place.
Wound closed and drain in place. Wound closed and drain in place.
Image of Obvious concavity at 14 days postoperatively.
Obvious concavity at 14 days postoperatively. Obvious concavity at 14 days postoperatively.
Image of Raising the flap.
Raising the flap. Raising the flap.
Image of Flap transposed, based on its distal interosseous pedicle.
Flap transposed, based on its distal interosseous pedicle. Flap transposed, based on its distal interosseous pedicle.
Image of Muscles of the superficial antebrachium, showing ulnaris lateralis.
Muscles of the superficial antebrachium, showing ulnaris lateralis. Muscles of the superficial antebrachium, showing ulnaris lateralis.
Image of Superficial muscles of the lateral thigh, showing the superficial gluteal muscle.
Superficial muscles of the lateral thigh, showing the superficial gluteal muscle. Superficial muscles of the lateral thigh, showing the superficial gluteal muscle.
Image of Tenotomy of the tendon of insertion and dorsal reflection of the muscle.
Tenotomy of the tendon of insertion and dorsal reflection of the muscle. Tenotomy of the tendon of insertion and dorsal reflection of the muscle.
Image of Transposition of the superficial gluteal muscle to augment perineal hernia repair.
Transposition of the superficial gluteal muscle to augment perineal hernia repair. Transposition of the superficial gluteal muscle to augment perineal hernia repair.
Image of Flap elevated and inverted.
Flap elevated and inverted. Flap elevated and inverted.
Image of Flap transposed to close the ventral aspect of a perineal hernia.
Flap transposed to close the ventral aspect of a perineal hernia. Flap transposed to close the ventral aspect of a perineal hernia.
Image of Skin incision over the medial aspect of the thigh to expose the cranial sartorius.
Skin incision over the medial aspect of the thigh to expose the cranial sartorius. Skin incision over the medial aspect of the thigh to expose the cranial sartorius.
Image of Transection of the muscle at the tibial insertion and dissection up to the proximal vascular pedicle.
Transection of the muscle at the tibial insertion and dissection up to the proximal vascular pedicle. Transection of the muscle at the tibial insertion and dissection up to the proximal vascular pedicle.
Image of Transposition of the cranial sartorius muscle through 180 degrees to augment the repair of a caudal abdominal hernia.
Transposition of the cranial sartorius muscle through 180 degrees to augment the repair of a caudal abdominal hernia. Transposition of the cranial sartorius muscle through 180 degrees to augment the repair of a caudal abdominal hernia.
Image of Wound closed.
Wound closed. Wound closed.
Image of Skin incision over the medial aspect of the thigh to expose the caudal sartorius.
Skin incision over the medial aspect of the thigh to expose the caudal sartorius. Skin incision over the medial aspect of the thigh to expose the caudal sartorius.
Image of Transection of the muscle 4 cm distal to its origin.
Transection of the muscle 4 cm distal to its origin. Transection of the muscle 4 cm distal to its origin.
Image of Transposition of the muscle flap distally.
Transposition of the muscle flap distally. Transposition of the muscle flap distally.
Image of Transection of the muscle insertion to give an island flap.
Transection of the muscle insertion to give an island flap. Transection of the muscle insertion to give an island flap.
Image of Wound closed.
Wound closed. Wound closed.
Image of Deep muscles of the lateral thigh, showing the rectus femoris.
Deep muscles of the lateral thigh, showing the rectus femoris. Deep muscles of the lateral thigh, showing the rectus femoris.
Image of Skin incision over the lateral thigh to expose the rectus femoris.
Skin incision over the lateral thigh to expose the rectus femoris. Skin incision over the lateral thigh to expose the rectus femoris.
Image of Transposition of the muscle flap proximally.
Transposition of the muscle flap proximally. Transposition of the muscle flap proximally.
Image of Deep muscles of the lateral thigh and crus, showing semitendinosus.
Deep muscles of the lateral thigh and crus, showing semitendinosus. Deep muscles of the lateral thigh and crus, showing semitendinosus.
Image of Transposition of the contralateral semitendinosus muscle, based on the proximal caudal gluteal pedicle, to augment a perineal hernia repair.
Transposition of the contralateral semitendinosus muscle, based on the proximal caudal gluteal pedicle, to augment a perineal hernia repair. Transposition of the contralateral semitendinosus muscle, based on the proximal caudal gluteal pedicle, to augment a perineal hernia repair.
Image of Superficial muscles of the lateral crus, showing the lateral head of the gastrocnemius.
Superficial muscles of the lateral crus, showing the lateral head of the gastrocnemius. Superficial muscles of the lateral crus, showing the lateral head of the gastrocnemius.
Image of Transposition of the distal end of the cranial tibial muscle to cover adjacent wounds of the crus.
Transposition of the distal end of the cranial tibial muscle to cover adjacent wounds of the crus. Transposition of the distal end of the cranial tibial muscle to cover adjacent wounds of the crus.
Image of Lateral aspect of the skull showing the temporalis muscle. The zygomatic arch has been removed from A to B.
Lateral aspect of the skull showing the temporalis muscle. The zygomatic arch has been removed from A to B. Lateral aspect of the skull showing the temporalis muscle. The zygomatic arch has been removed from A to B.
Image of Creation of a full-thickness, ventrally based rostral muscle flap with an incision in the transverse plane.
Creation of a full-thickness, ventrally based rostral muscle flap with an incision in the transverse plane. Creation of a full-thickness, ventrally based rostral muscle flap with an incision in the transverse plane.
Image of Creation of a partial-thickness, ventrally based rostral muscle flap with an incision in the sagittal plane.
Creation of a partial-thickness, ventrally based rostral muscle flap with an incision in the sagittal plane. Creation of a partial-thickness, ventrally based rostral muscle flap with an incision in the sagittal plane.
Image of Vascular supply to the sternocephalicus, sternothyroideus and sternohyoideus muscles. The cranial or caudal portions of these muscles can be transposed to adjacent areas, based on their respective pedicles.
Vascular supply to the sternocephalicus, sternothyroideus and sternohyoideus muscles. The cranial or caudal portions of these muscles can be transposed to adjacent areas, based on their respective pedicles. Vascular supply to the sternocephalicus, sternothyroideus and sternohyoideus muscles. The cranial or caudal portions of these muscles can be transposed to adjacent areas, based on their respective pedicles.
Image of The anatomy and blood supply to the trapezius muscle and outline of the myocutaneous flap.
The anatomy and blood supply to the trapezius muscle and outline of the myocutaneous flap. The anatomy and blood supply to the trapezius muscle and outline of the myocutaneous flap.
Image of Elevation of a trapezius osteomyocutaneous flap.
Elevation of a trapezius osteomyocutaneous flap. Elevation of a trapezius osteomyocutaneous flap.
Image of Transposition of the cervical portion of the trapezius muscle, based on pedicles from the superficial cervical artery and vein.
Transposition of the cervical portion of the trapezius muscle, based on pedicles from the superficial cervical artery and vein. Transposition of the cervical portion of the trapezius muscle, based on pedicles from the superficial cervical artery and vein.
Image of Ventral aspect of the thorax of a cat, showing the superficial and deep pectoral muscles. The right superficial pectoral muscle has been removed.
Ventral aspect of the thorax of a cat, showing the superficial and deep pectoral muscles. The right superficial pectoral muscle has been removed. Ventral aspect of the thorax of a cat, showing the superficial and deep pectoral muscles. The right superficial pectoral muscle has been removed.
Image of Incision of the origin of the deep pectoral muscle, and cranial transposition.
Incision of the origin of the deep pectoral muscle, and cranial transposition. Incision of the origin of the deep pectoral muscle, and cranial transposition.
Image of Landmarks for the latissimus dorsi and cutaneous trunci myocutaneous flaps.
Landmarks for the latissimus dorsi and cutaneous trunci myocutaneous flaps. Landmarks for the latissimus dorsi and cutaneous trunci myocutaneous flaps.
Image of Elevation of a latissimus dorsi muscle flap and transposition to cover a thoracic wall defect.
Elevation of a latissimus dorsi muscle flap and transposition to cover a thoracic wall defect. Elevation of a latissimus dorsi muscle flap and transposition to cover a thoracic wall defect.
Image of Lateral aspect of the thorax and abdomen illustrating the external abdominal oblique muscle.
Lateral aspect of the thorax and abdomen illustrating the external abdominal oblique muscle. Lateral aspect of the thorax and abdomen illustrating the external abdominal oblique muscle.
Image of Creation of a muscle flap by division of the fascial attachments and cranial transposition.
Creation of a muscle flap by division of the fascial attachments and cranial transposition. Creation of a muscle flap by division of the fascial attachments and cranial transposition.
Image of Closure of a caudal thoracic wall defect with the muscle flap, showing the neurovascular pedicle.
Closure of a caudal thoracic wall defect with the muscle flap, showing the neurovascular pedicle. Closure of a caudal thoracic wall defect with the muscle flap, showing the neurovascular pedicle.
Image of Wound closed.
Wound closed. Wound closed.
Image of Ventral aspect of the abdominal wall, showing the rectus abdominis and the cranial and caudal deep epigastric vessels.
Ventral aspect of the abdominal wall, showing the rectus abdominis and the cranial and caudal deep epigastric vessels. Ventral aspect of the abdominal wall, showing the rectus abdominis and the cranial and caudal deep epigastric vessels.
Image of Outline of the gracilis myocutaneous flap.
Outline of the gracilis myocutaneous flap. Outline of the gracilis myocutaneous flap.

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