1 / 29

Tensor Fascia Lata , Rectus Femoris , Gracilis Flaps

Tensor Fascia Lata , Rectus Femoris , Gracilis Flaps. Ian Maxwell. Tensor Fascia Lata. Overview. Classification: Mathes and Nahai type I muscle flap Pedicle length: up to 10cm Pedicle calibre : 1.5-2.5mm (artery) Uses Groin Ischium Perineum Lower abdomen Sacrum Trochanter.

kasia
Download Presentation

Tensor Fascia Lata , Rectus Femoris , Gracilis Flaps

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

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: 1.5-2.5mm (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. 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

  6. 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

  7. Dissection • Elevate flap from distal to proximal • More proximally, retractor placed between rectus femoris and vastuslateralis • 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

  8. Cases:

  9. Rectus Femoris

  10. 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

  11. 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

  12. Variations • With or without skin paddle • Most perforators within middle third of thigh • Innervated functional muscle

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

  14. 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

  15. Gracilis

  16. 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

  17. Anatomy • Origin = pubic ramus • Insertion = pesanserinus • 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

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

  19. 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

  20. 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

More Related