Figure 51.1 Soleus flap. Open full size image Introduction The soleus muscle, one of the components of the superficial posterior compartment of the leg, was used initially as a local flap, as described by Ger and later, by Mathes and Nahai. Since then, multiple surgical modalities have been described that have approached this flap in different ways and used it for different purposes, as both a…
Figure 50.1 Gastrocnemius Flap. Open full size image Introduction The gastrocnemius flap is one of the most useful flaps. Described very early, it has been proven to be easy to raise and very reliable. Typically, it can be used by non-specialized reconstructive surgeons, since its field of application concerns the area of the knee and upper part of the leg, which is frequently involved in injury…
Introduction The gracilis flap was described in 1972 by Orticochea, as a pedicled myocutaneous flap, and the first cases included a penile reconstruction and one of calcaneal soft tissue coverage. It was one of the first myocutaneous flaps described in humans, and in 1976, Harii published a series of gracilis free flaps for soft tissue cover and, in a separate paper, a functional free gracilis for…
Figure 48.1 Sural flap. Open full size image Introduction “It is not uncommon to find split skin grafts applied to an ulcer bed as the sole method of treatment. This can be successful, but failure is a common end result … because of a failure to treat the primary disease and an unreceptive bed of fibro-granulation tissue and/or underlying bone to support the thin split skin.”…
Figure 47.1 Radial forearm flap. Open full size image Introduction Drs. Yang and Gao of the Shenyang Military Hospital initially introduced the radial forearm flap, often called the “Chinese flap.” Cadaveric studies performed in 1978 identified this flap and subsequent clinical series published in the Chinese literature in 1981 sealed it as a viable reconstructive option. In 1980, a delegation of German surgeons visiting China saw…
Figure 46.1 Lateral arm flap. Open full size image Introduction The lateral arm flap (LAF) is a reliable septofasciocutaneous flap for local and free tissue transfer. Song et al. in 1982, Cormack and Lamberty in 1983, and Katsaros et al. in 1984 first reported the advantages of the conventional LAF. In its original design, the flap extends from the insertion of the deltoid muscle to the lateral epicondyle.…
Introduction This chapter covers a selection of pedicled flaps commonly used for soft tissue coverage of the hand. Several are based on primary vessel pedicles (Moberg flap, posterior interosseous artery flap, and homodigital island flaps), whereas others are based on secondary cutaneous branches of larger primary structures (ulnar artery perforator flap, cross finger flap). These provide a less complex and rapid means of achieving wound closure…
Introduction The gluteus maximus (GM) flap was initially described as a turnover muscle flap for sacral coverage, in 1974. During the following years, musculocutaneous GM flaps became the gold standard in the treatment of pressure ulcers because of their ability to fill dead space and to provide well-vascularized tissue to the ulcerated, often contaminated defect. The flap was expanded to several variations and was used successfully…
Figure 43.1 Groin flap and superficial circumflex iliac artery perforator flap. Open full size image Introduction The groin flap, nourished by the superficial circumflex iliac artery (SCIA), is historically important because it was the first successful free flap. With its concealed donor site, this flap was especially popular in children and young women. However, it is less commonly used nowadays due to the anatomic variations in…
Figure 42.1 Iliac flap. Open full size image Introduction The iliac crest provides a good source of bone and is universally accepted as a donor site for non-vascularized grafts. Its role as a vascularized graft for head and neck reconstruction has very much decreased in popularity since Hidalgo described the fibula flap for mandibular reconstruction in 1989. There is no doubt that the excellent depth and…
Figure 41.1 Latissimus dorsi flap. Open full size image Introduction The latissimus dorsi flap was introduced by Tansini in 1906 for the coverage of extensive mastectomy defects. Subsequently forgotten, it was re-described by Olivari in 1976 for the coverage of large radiation ulcers of the chest wall. Boswick, in 1978, adopted Olivari's idea and developed a latissimus island flap for breast reconstruction. A further development, together…
Introduction The skin and subcutaneous tissue of the back may be harvested as a flap supplied by the cutaneous or superficial branch of the circumflex scapular artery, originally named by Manchot. This branch is termed the “superficial circumflex scapular artery.” This skin artery divides into several branches: the horizontal (transverse) and vertical (descending), as well as the ascending and lateral branches. The horizontal and vertical branches…
Figure 39.1 Trapezius flap. Open full size image Introduction The trapezius muscle, with its unique triangular shape and great length, extends from the occiput down to the 12th thoracic vertebra and consists of descending, transverse, and ascending parts; its complexity renders a systematic description challenging. Since the upper trapezius myocutaneous flap was first published by McCraw et al. and Demergasso and Piazza in 1979 and the lower…
Introduction In 1904, Wiilstein, in Germany, reported the first case of a jejunal flap. He used the jejunum as a pedicled flap to reconstruct the thoracic esophagus. In 1907, Roux, in France, described a successful staged reconstruction of the esophagus using the jejunum. The most common complication was necrosis of the most cephalad portion of the flap. As a result, pedicled jejunal flaps were generally restricted…
Introduction The rectus abdominis muscle (RAM) flap and its variations are some of the most important flaps used in reconstructive surgery. Its popularity is explained by the location of its skin island in the inferior abdomen, which results in a skin resection similar to that of conventional abdominoplasties, especially in women undergoing breast reconstruction. The RAM flap was first described by Holmstron in 1979, who based…
Introduction The omentum flap was one of the first free flaps reported in the literature but long before that, its use as pedicled flap for intra- and extra-abdominal reconstructions was well described. The popularity of the omentum flap has been variable over the past decades but new harvesting techniques have been developed that aim to reduce donor site morbidity. In recent years, the superior epigastric flap…
Introduction The deltopectoral (DP) fasciocutaneous flap, also known as the Bakamjian flap, is an important reconstructive tool that has been used for a wide variety of reconstructive problems in head and neck surgery. A variation of this flap that is based on a single perforator of the internal mammary artery is called the “internal mammary artery perforator (IMAP) flap.” The DP flap was initially described for…
Introduction The pectoralis major myocutaneous flap for reconstruction was first described in 1968. Its application in the head and neck region, however, was not reported until Ariyan's publication in 1979. The reliability and versatility of this flap were subsequently confirmed by many other reports. During the 1980s and early 1990s, before the era of the microvascular free tissue transfer, the pectoralis major myocutaneous flap had been…
Introduction The supraclavicular flap was reported first by Lamberty in 1979. The flap was not reported on further until Pallua reported its use in cases of neck contracture reconstruction in 1997. Since that time, the flap has been widely used and reported on. The supraclavicular flap has been favored for head and neck reconstruction due to its match with color and texture of the recipient head…
Introduction The temporoparietal fascia flap (TPFF) is the thinnest, most pliable flap in the body, and can be used for moderate sized defects of up to 12 × 14 cm. The TPFF is highly vascularized and has a reliable arterial and venous pedicle. This flap's greatest strength is in its versatility, as it may carry hair-bearing scalp, contain vascularized bone, or provide a thin covering for the ear or…