This book provides a practical, step-by-step guidance on modern workhorse flaps for plastic and reconstructive surgeons in training or in their early career. The 50 chapters cover everything from surgical fundamentals to preconditions of microsurgical techniques, but also covers pre-operative planning, steps of microsurgical dissection and management of complications in a straightforward, explanatory style, and are supplemented by over 600 clinical illustrations and cadaveric images. Further videos demonstrations with pertinent steps in flap dissection, anatomical nomenclature and long-term outcomes are also demonstrated. For each flap a detailed discussion of key papers concerning its origin, pitfalls, technical refinements and tips for success are also included. Thanks to specific notes on common reconstructive challenges and complications, this book offers a valuable reference tool and would be unquestionably an integral reference guide for every surgeon interested in reconstructive microsurgical techniques, especially during their early microsurgical career.
Author(s): Dariush Nikkhah, Jeremy Rawlins, Georgios Pafitanis
Publisher: Springer
Year: 2023
Language: English
Pages: 495
City: Cham
Foreword
Preface
References
Acknowledgements
Contents
List of Videos
Part I: Introduction to Reconstructive Microsurgery
1: Microsurgery Essentials: Preconditions, Instrumentation, and Setup
1.1 Introduction
1.2 Surgical Magnification: Loupes and Microscopes
1.2.1 Surgical Loupes
1.2.2 Surgical Microscope
1.2.3 Heads-Up 3D Microscopy and Exoscopes
1.3 Microsurgical Equipment, Instruments, and Sutures
1.4 Microsurgical Training
1.4.1 Formal Microsurgery Training Curriculum
1.4.2 Home Microsurgical Training Setup
References
2: Basic and Advanced Microvascular Anastomotic Techniques
2.1 Introduction
2.2 Tissue Handling
2.3 Microvascular End-to-End Anastomotic Techniques
2.3.1 End-to-End Anastomosis Using Biangulation Technique
2.3.2 End-to-End Anastomosis Using One-Way-Up Technique
2.4 Microvascular End-to-Side Anastomotic Technique
2.4.1 Preparing Donor Vessel (Vessel End)
2.4.2 Preparing Recipient Vessel (Vessel Side)
2.4.3 Microsuture Technique for End-to-Side Anastomosis
2.5 Interpositional Venous Grafting
2.5.1 Preparation of the Artery
2.5.2 Preparation of Vein Graft
2.5.3 Microsuture Technique for Interpositional Vein Graft Technique
2.6 Supermicrosurgery and Future Perspectives
References
3: Decision-Making in Flap Surgery: Reconstructive Ladder Versus Elevator
3.1 Introduction: The History of Reconstructive Plastic Surgery
3.2 The Reconstructive Ladder vs. Elevator
3.3 The Reconstructive Toolbox
3.4 Defect Reconstruction: Function, Form and Aesthetic
3.5 Clinical Scenarios
3.6 Selected Readings
References
4: Assessment of Flap Perfusion: Microvascular Flowmetry
4.1 Introduction
4.1.1 Rationale for Microvascular Flowmetry
4.1.2 How Can Microvascular Flowmetry Help the Reconstructive Microsurgeon?
4.2 Intraoperative Flowmetry
4.2.1 Fluorescence Angiography
4.2.1.1 What Is It?
4.2.1.2 How Is It Used?
4.2.1.3 Technical Considerations and Limitations
4.2.2 Transit Time Volume Flowmetry
4.2.2.1 What Is It?
4.2.2.2 How Is It Used?
4.2.2.3 Technical Considerations and Limitations
4.3 Post-operative Flowmetry
4.3.1 Non-invasive
4.3.1.1 Laser Doppler
What Is It?
How Is It Used?
Technical Considerations and Limitations
4.3.1.2 Near-Infrared Spectroscopy
What Is It?
How Is It Used?
Technical Considerations and Limitations
4.3.1.3 Dynamic Infrared Thermography
What Is It?
How Is It Used?
Technical Considerations and Limitations
4.3.2 Invasive
4.3.2.1 Implantable Doppler
What Is It?
How Is It Used?
Technical Considerations and Limitations
4.4 Future Directions
4.4.1 Characteristics of an Ideal Flowmetry Device
4.5 Conclusions
4.6 Selected Readings
References
5: Re-exploration, Complications and Flap Salvage
5.1 Introduction
5.2 Preoperative Assessment
5.3 Perioperative Management
5.4 Post-operative Monitoring
5.4.1 Muscle Flap Monitoring
5.5 Flap Salvage
5.5.1 Algorithm for Re-exploration of Flap
5.5.1.1 Pedicle
5.5.1.2 Anastomoses
5.5.1.3 Flap Inset
5.5.1.4 Pharmacological Salvage
5.5.1.5 Hirudotherapy
5.5.1.6 Human Factors
5.6 Donor Site Morbidity
5.7 Summary
5.8 Selected Readings
References
6: The Use of Ultrasound Technology in Planning Perforator Flaps and Lymphatic Surgery
6.1 Introduction
6.2 Background
6.3 Color-Coded Duplex Sonography (CCDS)
6.4 Ultrahigh-Frequency Ultrasound (UHFUS)
6.5 Conclusions
References
7: Novel Microscopic Technologies in Reconstructive Microsurgery/Microvascular Surgery
7.1 Introduction
7.1.1 The Evolution of Operating Microscopy
7.1.2 Operating Microscopy in Reconstructive Microsurgery
7.2 Novel Microscopic Technologies
7.2.1 Visualisation Technologies
7.2.1.1 HD Displays and 3D Visualisation
7.2.1.2 Immersive Microscopy
Augmented Reality
Virtual Reality
7.2.2 Optical Imaging Modalities
7.2.2.1 Near-Infrared Fluorescence Imaging
7.2.2.2 Optical Coherence Tomography
7.2.2.3 Hyperspectral Imaging
7.2.2.4 Photoacoustic Microscopy
7.2.2.5 Laser Speckle Contrast Imaging
7.3 Heads-Up Operative Microscopes
7.3.1 The Exoscope
7.3.2 Hybrid Visualisation Systems
7.3.3 Head-Mounted Microscope
7.4 Clinical Applications of Microscopic Technologies in RM (Table 7.6)
7.5 Future Directions of Operating Microscopy
7.6 Conclusion
7.7 Selected Readings
References
8: Robotic Microvascular and Free Flap Surgery: Overview of Current Robotic Applications and Introduction of a Dedicated Robot for Microsurgery
8.1 Introduction
8.2 Robotic Systems
8.2.1 RAMS
8.2.2 AESOP
8.2.3 ZEUS
8.2.4 DaVinci
8.2.5 MUSA
8.3 Current Applications of Robotics in Microvascular and Free Flap Surgery
8.3.1 Robotic Flap Harvesting
8.3.1.1 Deep Inferior Epigastric Perforator Flap
8.3.1.2 Rectus Abdominis Muscle Flap
8.3.1.3 Internal Mammary Vessels
8.3.1.4 Miscellaneous
8.3.2 Robotic Microvascular Anastomosis
8.3.2.1 Preclinical Studies
8.3.2.2 Clinical Studies
8.3.3 Robotic Flap Inset
8.3.4 Robotic Supermicrosurgery
8.3.5 Robotic Microsurgical Training
8.4 Future Perspectives
8.5 Selected Readings
References
9: Technical Tips in Microvascular Surgery
9.1 Introduction
9.2 Modified Writing Position and Quadropod Grip
9.3 Airborne Suture Tying
9.4 One-Way-Up Technique
9.5 Continuous-Interrupted Suturing
9.6 Needle-Splint Technique
9.7 Crater Arteriotomy Technique
9.8 End-to-Patch Technique
9.9 Dealing with Non-spurting Recipient Arteries
9.10 Dealing with Large Vessel-Size Discrepancy
9.11 Fish-Mouth Microvascular Anastomosis Technique
9.12 Sliced-Pants Technique
References
Part II: Core Flaps
10: Temporal Artery Flaps
10.1 Introduction
10.2 Anatomy
10.3 Preoperative Investigation
10.4 Flap Design and Markings
10.5 Flap Elevation
10.6 Core Surgical Techniques in Flap Dissection
10.7 Clinical Scenario
10.8 Pearls and Pitfalls
10.9 Selected Readings
References
11: Supraorbital and Supratrochlear Artery Flaps - Forehead Flap and Modifications
11.1 Introduction
11.2 Anatomy
11.3 Preoperative Investigation
11.3.1 Flap Design and Markings: Multistage Forehead Flap
11.3.1.1 The Multistage Paramedian Forehead Flap
11.3.2 The Anterior Superficial Temporal Artery Flap
11.3.3 Flap Raise/Elevation: A Step-by-Step Guide
11.3.3.1 The Multistage Paramedian Forehead Flap
11.3.3.2 Point for Consideration
11.3.4 Anterior Superficial Temporal Forehead Flap
11.3.4.1 Patient Preparation, Marking and Surgery
11.3.5 Transverse Temporal Forehead Flaps
11.3.6 Core Surgical Techniques in Flap Dissection
11.3.6.1 Staged Considerations: Nasal Reconstruction
11.3.6.2 Intermediate Stages
11.3.6.3 Final Stage
11.3.6.4 Flap Delay
11.3.6.5 The Single-Stage Forehead Flap
11.3.6.6 Donor Site Management
11.3.6.7 Final Thoughts
11.4 Pearls and Pitfalls
11.5 Selected Readings
References
12: Cervicofacial Flap
12.1 Introduction
12.2 Anatomy
12.3 Preoperative Investigation
12.4 Flap Design and Markings
12.4.1 Anteriorly Based Flaps
12.4.2 Posteriorly Based Flaps
12.5 Flap Raise/Elevation: A Step-by-Step Guide
12.6 Core Surgical Techniques in Flap Dissection
12.7 Clinical Scenario
12.8 Pearls and Pitfalls
12.9 Selected Readings
References
13: Bowel Flaps - Jejunum Flap
13.1 Introduction
13.2 Anatomy
13.3 Preoperative Investigation
13.4 Flap Design and Markings
13.5 Flap Raise/Elevation: A Step-by-Step Guide
13.6 Core Surgical Techniques in Flap Dissection
13.7 Clinical Scenarios
13.8 Pearls and Pitfalls
13.9 Selected Readings
References
14: Thoracodorsal Artery Flap: Latissimus Dorsi Flap
14.1 Introduction
14.2 Anatomy
14.3 Preoperative Investigation
14.4 Flap Design and Markings
14.5 Flap Raise/Elevation: A Step-by-Step Guide
14.6 Core Surgical Techniques in Flap Dissection
14.7 Clinical Scenario
14.8 Pearls and Pitfalls
14.9 Selected Readings
References
15: Thoracodorsal Artery Perforator Flap
15.1 Introduction
15.2 Anatomy
15.2.1 Arterial Supply
15.2.2 Venous Drainage
15.2.3 Nerves
15.3 Preoperative Investigation
15.4 Flap Design and Markings
15.5 Flap Raise/Elevation: A Step-by-Step Guide
15.6 Core Surgical Techniques in Flap Dissection
15.7 Clinical Scenario
15.8 Pearls and Pitfalls
15.9 Selected Readings
16: The Scapular Axis Flaps: An Expendable Direct Cutaneous Perforator with Many Options
16.1 Introduction
16.2 Anatomy
16.3 Preoperative Investigation
16.4 Flap Design, Markings, and Positioning
16.5 Positioning
16.6 Flap Markings
16.7 Flap Elevation: A Step-by-Step Guide
16.7.1 Scapular Flap
16.7.2 Parascapular Flap
16.7.3 Osseus Flaps
16.8 Pearls and Pitfalls
16.9 Clinical Example
16.10 Selected Readings
Reference
17: Thoracoacromial Artery Flap: Pectoralis Major Muscle Flap
17.1 Introduction
17.2 Anatomy
17.3 Preoperative Investigation
17.4 Flap Design and Markings
17.5 Flap Raise/Elevation: A Step-by-Step Guide
17.5.1 Head and Neck Reconstruction
17.5.2 Sternal Reconstruction
17.6 Core Surgical Techniques in Flap Dissection
17.7 Clinical Scenario
17.8 Pearls and Pitfalls
17.9 Chimeric Thoracoacromial Pectoralis Major Flap
17.10 Selected Readings
References
18: Transverse Cervical Artery Flap - Supraclavicular Flap
18.1 Introduction
18.2 Anatomy
18.3 Preoperative Investigation
18.4 Flap Design and Markings
18.5 Flap Raise/Elevation: A Step-by-Step Guide
18.6 Core Surgical Techniques in Flap Dissection
18.7 Clinical Scenario
18.7.1 Supraclavicular Osteocutaneous (SOC) Free Flap
18.7.2 Supraclavicular Vascularized Lymph Node Transfer (VLNT)
18.8 Pearls and Pitfalls
18.9 Selected Readings
References
19: Inferior Epigastric Artery Flap: Deep Inferior Epigastric Artery Perforator Flap
19.1 Introduction
19.2 Anatomy
19.3 Preoperative Investigation
19.4 Flap Design and Markings
19.5 Flap Raise/Elevation: A Step-by-Step Guide
19.6 Core Surgical Techniques in Flap Dissection
19.6.1 Perforator Dissection
19.6.2 Nerve Preservation
19.6.3 Bipedicled and Stacked DIEP
19.7 Breast Neurotisation
19.8 Clinical Scenario
19.9 Pearls and Pitfalls
19.10 Selected Readings
References
20: Inferior and Superior Epigastric Artery Flaps: The Rectus Abdominis Muscle Flap
20.1 Introduction
20.2 Anatomy
20.3 Preoperative Investigation
20.4 Flap Design and Markings
20.5 Flap Raise/Elevation
20.6 Core Surgical Techniques in Flap Dissection
20.7 Clinical Scenario
20.8 Pearls and Pitfalls
20.9 Selected Readings
References
21: Superficial Inferior Epigastric Artery and Superficial Circumflex Iliac Artery Perforator Combined Flaps
21.1 Introduction
21.2 Anatomy (Fig. 21.1)
21.3 Preoperative Investigation
21.4 Flap Design and Markings
21.5 Flap Raise/Elevation: A Step-by-Step Guide
21.5.1 Vertical SIEA Flap (Figs. 21.5, 21.6, 21.7, and 21.8)
21.5.2 SCIP-SIEA Combined Flap (Figs. 21.9, 21.10, 21.11, and 21.12)
21.6 Core Surgical Techniques in Flap Dissection
21.6.1 Vertical SIEA Flap
21.6.2 SCIP-SIEA Combined Flap
21.7 Clinical Scenario
21.8 Pearls and Pitfalls
21.9 Selected Readings
22: Superior Gluteal Artery Perforator Flap
22.1 Introduction
22.2 Anatomy
22.3 Preoperative Investigation
22.4 Flap Design and Markings
22.5 Flap Raise/Elevation: A Step-by-Step Guide
22.6 Core Surgical Techniques in Flap Dissection
22.7 Clinical Scenario
22.8 Pearls and Pitfalls
22.9 Selected Readings
References
23: Inferior Gluteal Artery Perforator Flap
23.1 Introduction
23.2 Anatomy
23.3 Preoperative Investigation
23.4 Flap Design and Markings
23.4.1 Markings
23.5 Flap Raise/Elevation: A Step-by-Step Guide
23.6 Core Surgical Techniques in Flap Dissection
23.7 Clinical Scenario
23.8 Summary
23.9 Pearls and Pitfalls
23.10 Selected Readings
References
24: The Lumbar Artery Perforator Flap: A True Alternative in Autologous Breast Reconstruction
24.1 Introduction
24.2 Anatomy
24.3 Preoperative Investigation
24.4 Flap Design and Markings
24.5 Flap Raise/Elevation: A Step-by-Step Guide
24.5.1 Supine Position
24.5.1.1 Mastectomy and Recipient Vessels (Fig. 24.10)
24.5.1.2 Vascular Interposition Graft (Fig. 24.11)
24.5.2 Prone Position
24.5.2.1 Flap Harvest from Medial to Lateral (Figs. 24.12, 24.13, 24.14, 24.15, 24.16, 24.17, and 24.18)
24.5.3 Supine Position
24.5.3.1 Anastomosis Between the Perforator of the LAP Flap and the Vascular Interposition Graft (Fig. 24.19)
24.5.3.2 Flap Transfer to the Chest and Flap Insertion (Figs. 24.20 and 24.21)
24.6 Core Surgical Techniques in Flap Dissection
24.7 Clinical Scenario
24.8 Pearls and Pitfalls
24.9 Selected Readings
References
25: Right Gastroepiploic Artery: Omental Flap
25.1 Introduction
25.2 Anatomy
25.3 Preoperative Investigation
25.4 Flap Design and Markings
25.5 Core Surgical Techniques in Flap Dissection
25.6 Flap Raise: A Step-by-Step Guide
25.7 Clinical Scenario: The Use of the Greater Omentum in Deep Sternal Wound Infections (DSWI) and Nonunion of the Sternum
25.8 Pearls and Pitfalls
25.9 Selected Reading
26: Dorsal Metacarpal Artery Flaps
26.1 Introduction
26.2 Anatomy
26.3 Preoperative Investigation
26.4 Flap Design and Markings
26.5 Flap Raise/Elevation: A Step-by-Step
26.5.1 FDMA Flap (Foucher Flap)
26.5.2 Reverse Dorsal Metacarpal Flap.
26.6 Core Surgical Techniques in Flap Dissection
26.7 FDMA Flap
26.7.1 Reverse Dorsal Metacarpal Artery Perforator (Quaba) Flap.
26.8 Clinical Scenario
26.8.1 Case Scenario A: Figs. 26.2, 26.4, 26.5, 26.6, 26.7, and 26.8 Surgeon Dariush Nikkhah
26.8.2 Case Scenario B: Figs. 26.3, 26.10, 26.12, 26.13, 26.14, and 26.15 Surgeon Dariush Nikkhah
26.9 Pearls and Pitfalls
26.10 Selected Readings
References
27: Digital Artery Flaps: Homodigital and Heterodigital Island Flaps
27.1 Introduction
27.2 Anatomy of Homo- and Heterodigital Island Flaps
27.3 Preoperative Investigation
27.4 Flap Design and Markings
27.4.1 Reverse Homodigital Island Flap
27.4.2 Heterodigital Island Flap
27.5 Flap Raise/Elevation: A Step-by-Step Guide
27.5.1 Reverse Homodigital Island Flap
27.5.2 Heterodigital Island Flap
27.6 Core Surgical Techniques
27.6.1 Reverse Homodigital Island Flap: Surgeon Dariush Nikkhah
27.6.2 Heterodigital Island Flap: Surgeon Dariush Nikkhah
27.7 Clinical Scenario
27.7.1 Reverse Homodigital Island Flap: Surgeon Dariush Nikkhah
27.7.2 Heterodigital Island Flap: Surgeon Dariush Nikkhah
27.8 Pearls and Pitfalls [10–18]
27.9 Selected Readings
References
28: Radial Forearm Flap
28.1 Introduction
28.2 Anatomy
28.3 Preoperative Investigation
28.4 Flap Design and Markings
28.5 Flap Raise/Elevation: A Step-by-Step Guide
28.6 Core Surgical Techniques in Flap Dissection
28.6.1 Skin Paddle Design
28.6.2 Ulnar to Radial Approach
28.6.3 Osteocutaneous Flap
28.6.4 Flap Dissection and Instrumentation
28.6.5 Tendon Inclusion
28.6.6 Vein Harvest
28.6.7 Donor Site
28.7 Clinical Scenario
28.7.1 Clinical Scenario A: Surgeons Jeremy Rawlins and Qadir Khan
28.7.2 Clinical Scenario B: Surgeons Dariush Nikkhah and Norbert Kang
28.7.3 Clinical Scenario C: Surgeons Dariush Nikkhah and Allan Ponniah
28.8 Pearls and Pitfalls [13]
28.9 Selected Readings
References
29: Posterior Interosseous Artery Flap
29.1 Introduction
29.1.1 Characteristics (Types)
29.1.1.1 Distally Based PIA Flap
29.1.1.2 Anterograde PIA Flap
29.1.1.3 Fascia-Only Reverse PIA Flap
29.1.1.4 Extended PIA Flap
29.2 Anatomy
29.2.1 Anatomical Variations
29.3 Preoperative Investigation
29.4 Flap Design and Markings
29.5 Flap Raise/Elevation: A Step-by-Step Guide
29.6 Core Surgical Techniques in Flap Dissection
29.7 Clinical Scenario
29.7.1 Scenario A (Dorsum of the Hand/MCPJ): Surgeon Dariush Nikkhah
29.7.1.1 Case 1: Video 29.1: Surgeon Dariush Nikkhah
29.7.1.2 Case 2: Video 29.2: Surgeon Mark Pickford
29.7.2 Scenario B (Dorsum of the Hand Free PIA Flap): Surgeon Petr Vondra
29.8 Pearls and Pitfalls
29.9 Selected Readings
References
30: Venous Flaps
30.1 Introduction
30.2 Anatomy
30.3 Preoperative Investigation
30.4 Flap Design and Markings
30.5 Flap Raise/Elevation: A Step-by-Step Guide
30.6 Core Surgical Techniques in Flap Dissection
30.7 Clinical Scenario: Surgeon Jamil Moledina
30.8 Pearls and Pitfalls
30.9 Selected Readings
References
31: Free Thenar Flap
31.1 Introduction
31.2 Anatomy
31.3 Preoperative Investigation
31.4 Flap Design and Markings
31.5 Flap Raise/Elevation
31.6 Core Surgical Techniques in Flap Dissection
31.7 Clinical Scenarios
31.8 Pearls and Pitfalls
31.9 Selected Readings
References
32: Medial and Lateral Arm Fasciocutaneous Flaps
32.1 Introduction
32.1.1 First Description, Origin and Evolution of Medial Arm Flap Vascularity
32.1.2 Medial Arm Flap Characteristics
32.1.3 Common Indications
32.2 Anatomy
32.2.1 Vascular Supply: Superior Ulnar Collateral Artery (SUCA)
32.2.2 Nerve Supply
32.2.2.1 Anatomical Studies (Vasculature or Angiosomes)
32.3 Preoperative Investigation
32.4 Flap Design and Markings
32.5 Flap Raise/Elevation: A Step-by-Step Guide
32.6 Core Surgical Techniques in Flap Dissection
32.6.1 Standard Flap
32.6.2 Reverse Flap
32.6.3 Free Flap
32.7 Clinical Scenarios
32.7.1 Medial Arm Flap
32.7.2 Lateral Arm Flap
32.8 Pearls and Pitfalls
32.9 Selected Readings
33: The Groin Flap: The Workhorse Flap for Upper Limb Reconstruction
33.1 Introduction
33.2 Anatomy
33.3 Preoperative Investigation
33.4 Flap Design and Markings
33.5 Flap Raise/Elevation: A Step-by-Step Guide
33.6 Core Surgical Techniques in Flap Dissection
33.7 Clinical Scenario
33.7.1 Clinical Scenario A: Dr. Sabapathy and Dr. Venkatrami: Loss of Thumb Following Trauma (Figs. 33.6, 33.7, 33.8, 33.9, 33.10, 33.11, 33.12, and 33.13)
33.7.2 Clinical Scenario B: Dr Dariush Nikkhah and Dr Jeremy Rawlins Elbow Resurfacing with Free Groin Flap
33.7.3 Case Scenario C: Dr Sabapathy and Dr Venkatrami
33.8 Pearls and Pitfalls
33.9 Selected Readings
References
34: Superficial Circumflex Iliac Artery Perforator Flap: A Thin and Versatile Option for Limb and Head and Neck Reconstruction
34.1 Introduction
34.2 Anatomy
34.3 Pre-Operative Investigation
34.4 Flap Design and Markings
34.5 Flap Raise/Elevation: A Step-by-Step Guide
34.6 Core Surgical Techniques in Flap Dissection
34.7 Clinical Scenario
34.8 Pearls and Pitfalls
34.9 Selected Readings
References
35: Lateral Circumflex Femoral Artery—Anterolateral Thigh Flap: Anterolateral Thigh Flap
35.1 Introduction
35.2 Anatomy
35.3 Pre-Operative Investigation
35.4 Flap Design and Markings
35.5 Flap Raise/Elevation: A Step-by-Step Guide
35.6 Core Surgical Techniques in Flap Dissection
35.7 Clinical Scenario
35.8 Pearls and Pitfalls
35.9 Selected Readings
References
36: Transverse Upper Gracilis (TUG) Flap: A Reliable Alternative for Breast Reconstruction
36.1 Introduction
36.2 Anatomy
36.3 Pre-Operative Investigation
36.4 Flap Design and Markings
36.5 Flap Raise/Elevation: A Step-by-Step Guide
36.6 Core Surgical Techniques in Flap Dissection
36.7 Clinical Scenario
36.7.1 Bilateral TUG
36.7.2 Unilateral TUG
36.8 Pearls and Pitfalls
36.9 Selected Readings
References
37: Medial Circumflex Femoral Artery: Gracilis Muscle Flap
37.1 Introduction
37.2 Anatomy
37.3 Pre-Operative Investigations
37.4 Flap Design and Markings
37.4.1 Marking
37.4.2 Flap Design
37.5 Flap Raise/Elevation – A Step-by-Step Guide
37.6 Core Surgical Techniques in Flap Dissection
37.7 Clinical Scenario
37.7.1 Case 1: Facial Reanimation: Surgeon Graeme Glass
37.7.2 Case 2: Upper Limb Reanimation: Surgeons Dariush Nikkhah and Jeremy Rawlins
37.8 Pearls and Pitfalls
37.9 A Note on Monitoring Muscle Flaps for Vascular Compromise
37.10 Selected Readings
References
38: Profunda Artery Perforator Flap
38.1 Introduction
38.2 Anatomy
38.3 Pre-Operative Investigation
38.4 Flap Design and Markings
38.5 Flap Raise/Elevation: A Step-by-Step Guide
38.6 Core Surgical Techniques in Flap Dissection
38.7 Clinical Scenario
38.7.1 Scenario 1
38.7.2 Scenario 2
38.8 Pearls and Pitfalls
38.9 Selected Readings
39: Medial Femoral Condyle Flap
39.1 Introduction
39.2 Anatomy
39.3 Preoperative Investigation
39.4 Flap Design and Markings
39.5 Flap Raise/Elevation: A Step-by-Step Guide
39.6 Core Surgical Techniques in Flap Dissection
39.7 Clinical Scenario
39.8 Pearls and Pitfalls
39.9 Selected Readings
References
40: Medial Sural Artery Perforator Flap
40.1 Introduction
40.2 Anatomy
40.3 Pre-operative Investigation
40.4 Flap Design and Markings
40.5 Flap Raise/Elevation: A Step-by-Step Guide
40.6 Core Surgical Techniques in Flap Dissection
40.7 Clinical Scenarios
40.7.1 Case 1
40.7.1.1 Partial Glossectomy Reconstruction
40.7.2 Case 2
40.7.2.1 Pharyngeal Cancer Reconstruction
40.7.3 Case 3
40.7.3.1 Open Ankle Wound Post-septic Arthritis
40.8 Pearls and Pitfalls
40.9 Selected Readings
References
41: Peroneal Artery Flaps: The Free Fibula Flap
41.1 Introduction
41.2 Anatomy
41.2.1 Bony
41.2.2 Fascial
41.2.3 Vascular
41.2.4 Nerves
41.3 Pre-operative Investigations
41.4 Flap Design and Markings
41.5 Flap Raise/Elevation: A Step-by-Step Guide
41.6 Core Surgical Techniques in Flap Dissection
41.7 Clinical Scenario A: Surgeons Dariush Nikkhah, Qadir Khan, and Jeremy Rawlins
41.8 Clinical Scenario B: Surgeons Dariush Nikkhah, Qadir Khan, and Jeremy Rawlins
41.9 Pearls and Pitfalls
41.10 Selected Readings
References
42: Posterior Tibial and Peroneal Perforators Flaps
42.1 Introduction
42.2 Anatomy
42.2.1 Posterior Tibial Artery Perforator Flap
42.2.2 Peroneal Artery Perforator Flap
42.3 Preoperative Investigation
42.4 Flap Design and Markings
42.5 Flap Raise/Elevation – A Step-By-Step guide
42.6 Core Surgical Techniques in Flap Dissection (Propeller Flaps)
42.7 Clinical Scenario
42.8 Pearls and Pitfalls
42.9 Selected Readings
References
43: Second Toe Free Flap
43.1 Introduction
43.2 Anatomy
43.3 Pre-operative Investigation
43.4 Flap Design and Markings
43.5 Flap Raise/Elevation: A Step-by-Step
43.6 Core Surgical Techniques in Flap Dissection
43.7 Clinical Scenario
43.7.1 Case Scenario A: Congenital Hand—Symbrachydactyly—Surgeon Mark Pickford
43.7.2 Case Scenario B: Traumatic Injury to the Hand—Surgeon Mark Pickford
43.7.3 Case Scenario C: Firework Injury to Hand—Surgeon Petr Vondra
43.8 Pearls and Pitfalls
43.9 Selected Readings
References
44: Great Toe Flaps
44.1 Introduction
44.2 Anatomy
44.3 Pre-operative Investigation
44.4 Flap Design and Markings
44.5 Flap Raise/Elevation: A Step-by-Step Guide
44.5.1 Great Toe Flap Elevation
44.6 Core Surgical Techniques in Flap Dissection
44.7 Clinical Scenario
44.7.1 Scenario A: Delayed Great Toe Flap Surgeon Norbert Kang
44.7.2 Scenario B: Delayed Great Toe Hemi-Pulp Transfer Surgeon Norbert Kang
44.7.3 Scenario C: Immediate Great Toe to Hand Transplant Surgeon Dariush Nikkhah
44.8 Pearls and Pitfalls
44.9 Selected Readings
References
45: The Medial Plantar Flap
45.1 Introduction
45.2 Anatomy
45.3 Pre-operative Investigation
45.4 Flap Design and Markings
45.5 Flap Raise/Elevation: A Step-by-Step Guide
45.6 Core Surgical Techniques in Flap Dissection
45.7 Clinical Scenario
45.8 Pearls and Pitfalls
45.9 Selected Readings
References
Part III: Common Recipient Vessels
46: Chest Wall Recipient Vessels Access
46.1 Indications
46.2 Anatomy
46.3 Pre-operative Investigation
46.4 Recipient Vessel Access (A Figure with Surface Markings)
46.5 Recipient Vessel Dissection: A Step-by-Step Guide
46.6 Core Surgical Techniques in Recipient Vessel
46.7 Pearls and Pitfalls
46.8 Selected Readings
References
47: Head and Neck Recipient Vessels Access
47.1 Indications
47.2 Anatomy
47.2.1 Arterial Anatomy
47.2.2 Venous Anatomy
47.3 Pre-operative Investigation
47.4 Recipient Vessel Access
47.5 Recipient Vessel Dissection: A Step-by-Step Guide
47.5.1 Facial Artery (FA)
47.5.2 Superior Thyroid Artery (STA)
47.5.3 Superficial Temporal Artery (SuTA)
47.5.4 Transverse Cervical Artery (TCA)
47.5.5 Venous Recipients
47.6 Core Surgical Techniques in Recipient Vessel Harvesting
47.6.1 Microvascular Anastomosis
47.7 Pearls and Pitfalls
47.8 Selected Readings
References
48: Upper Limb Recipient Vessels Access
48.1 Indications
48.2 Anatomy
48.2.1 Antecubital Fossa
48.2.2 Forearm/Wrist
48.2.3 Hand
48.3 Pre-operative Investigation
48.4 Recipient Vessel Access (A Figure with Surface Markings)
48.5 Recipient Vessel Dissection: A Step-by-Step Guide
48.5.1 Brachial Artery: Antecubital Fossa (Fig. 48.6a)
48.5.2 Radial Artery; Distal Forearm (Fig. 48.6b)
48.5.3 Radial Artery: Anatomical Snuffbox (Fig. 48.6c)
48.5.4 Ulnar Artery: Distal Forearm (Fig. 48.6d, e)
48.6 Core Surgical Techniques in Recipient Vessel Harvest
48.6.1 Brachial Artery
48.6.2 Radial Artery
48.6.3 Ulnar Artery
48.7 Pearls and Pitfalls
48.8 Selected Readings
References
49: Lower Limb Recipient Vessels Access
49.1 Indications
49.2 Anatomy
49.3 Pre-operative Investigation
49.4 Recipient Vessel Access [See Fig. 49.2 for Leg Surface Markings]
49.5 Core Surgical Techniques in Recipient Vessel Harvest
49.6 Pearls and Pitfalls
49.7 Selected Readings
References
50: Lymphatic Supermicrosurgery
50.1 Indications of Lymphatic Supermicrosurgery
50.2 Anatomy and Preoperative Imaging of Lymphatic System
50.3 Recommended Surgical Sites for Lymphedema and Lympho-rrhea/-cyst (A Figure with Surface Markings)
50.4 Supermicrosurgical LVA for Lymphedema: A Step-by-Step Guide
50.5 Supermicrosurgical LLA for Lympho-rrhea/-cyst: A Step-by-Step Guide
50.6 Pearls and Pitfalls
50.7 Selected Readings
Part IV: Appendix
51: Cadaveric Anatomy: Microvascular Flaps Dissection
