Flaps and Reconstructive Surgery E-Book

 
 
Elsevier (Verlag)
  • 2. Auflage
  • |
  • erschienen am 26. August 2016
  • |
  • 828 Seiten
 
E-Book | ePUB mit Adobe DRM | Systemvoraussetzungen
E-Book | PDF mit Adobe DRM | Systemvoraussetzungen
978-0-323-26070-1 (ISBN)
 

With coverage of nearly twice the number of flaps as the previous edition, Flaps and Reconstructive Surgery, 2nd Edition provides trainees and practicing surgeons alike with the detailed, expert knowledge required to ensure optimal outcomes. It includes chapters and expert commentaries from more than 100 authors and world-renowned leaders in the field, while brand-new cases and high-quality illustrations focused on flap harvest, markings, and reconstruction keep you abreast of today's latest developments.

    • Includes high-quality illustrations of regional anatomy, flap anatomy, and step-by-step flap dissections, as well as clear photographs demonstrating successful reconstructions.
    • Detailed case studies illustrate how to optimize every aspect of care for the reconstructive surgery patient, including the postoperative period and long-term follow-up.
      • Brand-new section on reconstruction takes an algorithmic approach to the reconstruction of defects around the body.
      • Features chapters covering the entire spectrum of reconstructive surgery, including head and neck reconstruction, chest wall reconstruction, abdominal wall, upper and lower extremity, and facial reanimation.
      • Content focuses on both local and free flaps.
      • New section on reconstructive transplant surgery highlights major topics such as face and hand transplantations, abdominal wall transplantation, uterus transplantation, and nerve allotransplantation.
      • Englisch
      • Philadelphia
      • |
      • USA
      Elsevier Health Sciences
      • 242,32 MB
      978-0-323-26070-1 (9780323260701)
      0323260705 (0323260705)
      weitere Ausgaben werden ermittelt
      • Front Cover
      • Inside Front Cover
      • Flaps and Reconstructive Surgery
      • Copyright Page
      • Table Of Contents
      • Video Table of Contents
      • List of Chapter Contributors
      • List of Expert Commentary Contributors
      • Video Contributor List
      • Preface
      • Dedication
      • Acknowledgments
      • 1 Principles
      • 1 Problem Analysis in Reconstructive Surgery
      • History of Reconstructive Surgery
      • The Reconstructive Ladder
      • The Reconstructive Elevator
      • Surgical Judgment
      • The Present State of Reconstructive Surgery
      • A Modified Reconstructive Ladder/Elevator
      • Reconstructive Microsurgery
      • The Future of Microsurgery
      • References
      • 2 Classification of Flaps
      • Introduction
      • A Brief History of Flaps
      • Skin Flaps and Their Classification
      • Cormack and Lamberty Classification
      • Mathes and Nahai Classification
      • Nakajima Classification
      • Taylor's "Angiosome" Concept-Based Classification
      • Muscle Flaps
      • Mathes and Nahai Muscle Flap Classification
      • Taylor Classification
      • Other Flaps
      • Serafin Classification
      • Combined Flaps
      • Conjoined Flaps
      • Chimeric Flaps
      • Secondary Characteristics
      • Perforator Flaps
      • Vascularized Composite Allotransplantation Classification
      • Conclusion
      • References
      • 3 Considerations in Flap Selection
      • Introduction
      • The Recipient Site
      • The Donor Site
      • Role of Combined Flaps
      • Future Considerations
      • References
      • 4 Emerging Technology in Reconstructive Surgery
      • Introduction
      • Virtual Surgical Planning and Rapid Prototype Modeling
      • Mandibular and Maxillary Reconstruction
      • Orbital Reconstruction
      • Intraoperative Stereotactic Navigation
      • Assessment of Tissue Perfusion with Indocyanine Green Angiography
      • Free Flap Perfusion
      • Free Flap Design
      • Mastectomy Skin Flap Necrosis
      • Lymphatic Surgery
      • Preoperative Planning with Computed Tomography Angiography
      • Breast Reconstruction
      • Use in Designing Other Free Flaps
      • Three-Dimensional Imaging Systems
      • Conclusions
      • References
      • 5 Prefabrication and Prelamination
      • Introduction
      • Flap Prefabrication
      • Concept
      • Technique
      • Flap Maturation
      • Flap Transfer
      • Clinical Examples
      • Flap Prelamination
      • Concept
      • Technique
      • Flap Maturation
      • Flap Transfer
      • Clinical Examples
      • Conclusion
      • References
      • 6 Tissue Engineering
      • Introduction
      • Mechanisms of Action
      • Current Strategies in Tissue Engineering
      • Complex Scaffolds and Matrices
      • Fundamental Role of Vascularization
      • Proangiogenic Strategies
      • Decellularization of Tissues to Obtain the Ideal Scaffold
      • Cells and Stem Cells: the Substrate
      • Pluripotent Stem Cells for Use in Autologous Conditions
      • Induced Pluripotent Stem Cells
      • Multipotent Stem Cells for Use in Autologous Conditions
      • Unipotent Progenitor Cells
      • Blood Outgrowth Endothelial Cells
      • Tissue Engineering-Based Clinical Applications
      • Skin
      • Epidermal Substitutes
      • Dermal Substitutes
      • Compound Substitutes with Epidermal and Dermal Elements
      • De-Novo Assembly of Matrices
      • Urethra and Bladder
      • Bone
      • Trachea
      • The Cardiovascular System
      • Vascular Grafts
      • Cell Therapy for Myocardium
      • Heart Valves
      • Conclusion
      • References
      • 7 Percutaneous Aponeurotomy and Lipofilling (PALF):
      • Introduction
      • 2-D Application of PALF
      • 3-D Application of PALF
      • Cicatrix to Matrix
      • Keys to Fat Grafting
      • Surface Area-to-Volume Ratio.
      • Interstitial Fluid Pressure.
      • Recipient Site Vascularity.
      • Ability to Differentiate Necrotic Cysts from Cancer.
      • General Fat Grafting Techniques
      • Fat Harvest
      • Fat Processing
      • Fat Delivery
      • Postoperative Support
      • Reverse Abdominoplasty and Fat Transfer
      • References
      • 8 Lymphedema:
      • Introduction
      • Lymphatic Anatomy and Physiology
      • Pathophysiology
      • Indications for Lymphatic Surgery
      • Contraindications to Physiologic Procedures
      • The Initial Patient Visit
      • Anatomic Imaging
      • Functional Imaging
      • Lymphoscintigraphy
      • Indocyanine Green Lymphangiography
      • Lymphaticovenular Anastomosis Versus Vascularized Lymph Node Transfer
      • Lymphaticovenular Anastomosis
      • Operative Technique
      • Postoperative Management
      • Treatment of Upper Extremity Lymphedema with Lymph Node Transfer
      • Flap Options
      • Recipient Site
      • Preparation of the Axillary Recipient Site
      • Vascularized Groin Lymph Node Transfer with Reverse Lymphatic Mapping
      • Anatomy and Flap Design
      • Treatment of Lower Extremity Lymphedema with Vascularized Lymph Node Transfer
      • Vascularized Axillary Lymph Node Transfer with Reverse Lymphatic Mapping
      • Donor Site
      • Recipient Site Preparation
      • Medial Sural Vessels
      • Vascularized Supraclavicular Lymph Node Transfer with Reverse Lymphatic Mapping
      • Flap Markings and Elevation
      • Postoperative Management
      • Outcomes
      • Conclusion
      • References
      • 9 Robotic Applications in Plastic and Reconstructive Surgery
      • Introduction
      • Operating Interface
      • Robotic Operating Team
      • Transoral Robotic Surgery (TORS)
      • Indications
      • Robotic Muscle Harvest
      • Indications
      • Robotic Microvascular Anastomosis
      • Indications
      • Future Directions
      • Summary
      • References
      • 2 Clinical Anatomy and Recipient Vessel Anatomy, Selection, and Exposure
      • 10 Clinical Anatomy of the Head and Neck, and Recipient Vessel Selection
      • Introduction
      • Anatomy of the Head and Neck
      • Anatomy of the Facial Skeleton
      • The Fascia of the Head and Neck
      • Anatomy of the Facial Musculature
      • Arterial Anatomy of the Head and Neck
      • Facial Artery
      • Advantages and Disadvantages
      • Exposure of the Facial Artery
      • Submental Artery
      • Advantages and Disadvantages
      • Superior Thyroid Artery
      • Advantages and Disadvantages
      • Exposure of the Superior Thyroid Artery
      • Superficial Temporal Artery
      • Advantages and Disadvantages
      • Exposure of the Superficial Temporal Artery
      • Transverse Cervical Artery
      • Advantages and Disadvantages
      • Exposure of the Transverse Cervical Artery
      • Supratrochlear Artery
      • Venous Anatomy of the Head and Neck
      • Facial Venous System
      • Advantages and Disadvantages
      • Veins in the Head and Neck
      • Advantages and Disadvantages
      • Nerves in the Head and Neck
      • The Facial Nerve
      • Conclusion
      • References
      • 11 Clinical Anatomy and Recipient Vessel Selection in the Chest, Abdomen, Groin, and Back
      • Introduction
      • Muscular Anatomy by Region
      • The Chest
      • The Abdomen
      • The Back
      • Arterial Anatomy by Region
      • The Chest
      • The Anatomy and Exposure of the Subscapular System
      • The Anatomy and Exposure of the Internal Mammary Artery
      • The Anatomy and Exposure of the Lateral Thoracic Artery
      • The Anatomy and Exposure of the Thoracoacromial Artery
      • Advantages and Disadvantages of Recipient Arteries for Reconstruction of the Chest Region
      • The Abdomen
      • The Anatomy and Exposure of the Inferior Epigastric Artery
      • The Anatomy and Exposure of the Femoral Artery
      • The Anatomy and Exposure of the Superificial Inferior Epigastric and Circumflex Iliac Arteries
      • The Anatomy and Exposure of the Intercostal Artery
      • Advantages and Disadvantages of Recipient Arteries for Reconstruction of the Abdomen and Groin Regions
      • The Back
      • Additional Venous Anatomy
      • The Anatomy and Exposure of the Cephalic Vein
      • The Anatomy and Exposure of the External Jugular Vein
      • Nerve Anatomy by Region
      • The Chest
      • The Abdomen and Groin
      • The Back
      • Conclusion
      • Further Reading
      • 12 Clinical Anatomy and Recipient Vessel Selection in the Upper Extremity
      • Introduction
      • Anatomy of the Arm
      • Vascular Anatomy of the Arm
      • The Brachial Artery
      • Branches of the Brachial Artery
      • Anastomoses Around the Elbow
      • Exposure of the Brachial Artery in the Medial Arm
      • Gross Regional Anatomy of the Antecubital Fossa
      • Exposure of the Distal Brachial Artery and Its Bifurcation
      • Gross Regional Anatomy of the Forearm
      • Vascular Anatomy of the Forearm
      • The Ulnar Artery
      • Branches of the Ulnar Artery
      • Exposure of the Ulnar Artery in the Distal Forearm and Guyon's Canal
      • The Radial Artery
      • Exposure of the Radial Artery in the Distal Forearm and Anatomic Snuffbox
      • Nerve Anatomy of the Arm and Forearm
      • The Ulnar Nerve
      • The Median Nerve
      • The Musculocutaneous Nerve
      • The Radial Nerve
      • Cutaneous Nerves of the Forearm
      • Gross Regional Anatomy of the Hand
      • Vascular Anatomy of the Hand
      • The Superficial Palmar Arch and the Digital Arteries
      • The Deep Palmar Arch and Princeps Pollicis
      • Venous Anatomy of the Arm, Forearm, and Hand
      • Recipient Vessel Selection in the Upper Extremity
      • Anesthetic and Intraoperative Considerations
      • References
      • 13 Clinical Anatomy and Recipient Vessel Selection and Exposure in the Lower Extremity
      • Introduction
      • Anatomy of the Thigh
      • Nerves
      • Arterial Anatomy of the Thigh
      • Common Femoral Artery
      • Exposure of the Common Femoral Artery
      • Deep Femoral Artery (Profunda Femoris) (Fig. 13.2)
      • Exposure of Branches of the Deep Femoral Artery
      • Superficial Femoral Artery
      • Exposure of the Superficial Femoral Artery and Its Branches
      • Anatomy of the Leg
      • Nerves
      • Arterial Anatomy of the Leg
      • Popliteal Artery
      • Exposure of the Popliteal Artery
      • Posterior Tibial Artery
      • Exposure of the Posterior Tibial Artery
      • Peroneal Artery
      • Exposure of the Peroneal Artery
      • Anterior Tibial Artery
      • EXPOSURE OF THE ANTERIOR TIBIAL ARTERY
      • Anatomy of the Foot
      • Nerves
      • Arterial Anatomy of the Foot
      • The Dorsalis Pedis Artery
      • Plantar Vascular System
      • Anatomic Variations
      • Exposure of the Anterior Tibial and Dorsalis Pedis Arteries
      • Choosing an Inflow Vessel
      • Lower Extremity Venous Anatomy
      • Anatomy and Exposure of the Great Saphenous Vein
      • Anatomy and Exposure of the Small Saphenous Vein
      • Anatomy and Exposure of the Dorsal Venous Arch
      • Choosing an Outflow Vessel
      • Additional Considerations for Recipient Vessel Selection
      • High Incidence of Post-Traumatic Defects
      • Vascular Pathology with a Two- or One-Vessel Leg
      • Vascular Spasm
      • Patient Positioning
      • Anesthetic Considerations
      • Conclusion
      • References
      • 3 Reconstruction
      • 14 Head and Neck Reconstruction
      • Introduction
      • Preoperative Considerations
      • Critical Concepts of Craniofacial Microvascular Reconstruction
      • Aesthetic Subunit Appearance
      • Defect Boundaries
      • Tissue Requirements
      • Bone and Soft Tissue Support
      • Soft Tissue Volume
      • Timing
      • Secondary Revisions
      • Indications
      • Regions of the Head and Neck
      • Scalp and Forehead
      • Periorbit
      • Midface
      • Nose
      • Mandible
      • Tongue
      • Esophagus
      • Voice
      • Free Flap Choices for Craniofacial Reconstruction
      • Ulnar Forearm Flap
      • Anatomy
      • Surgical Technique
      • Application, Advantages, and Disadvantages
      • Anterolateral Thigh (ALT) Flap
      • Application, Advantages, and Disadvantages
      • Groin Flap
      • Application, Advantages, and Disadvantages
      • Deep Circumflex Iliac Artery Flap
      • Application, Advantages, and Disadvantages
      • Fibula Flap
      • Application, Advantages, and Disadvantages
      • Postoperative Considerations
      • Complications
      • Outcomes
      • Key References
      • References
      • 15 Facial Reanimation
      • Introduction and Historic Review
      • Nerve Transfers
      • Etiology of Facial Paralysis
      • Etiology and Lesion Location
      • Intracranial
      • Intratemporal
      • Extratemporal
      • Mechanism of Injury and Impairment
      • Clinical Presentation
      • Upper Face
      • Frontalis Muscle
      • Eye Sphincter
      • Normal Blink Reflex
      • Middle Face
      • Levator Muscles of the Upper Lip and Orbicularis Oris (OOrM)
      • Lower Face
      • Depressor Complex
      • Platysma
      • Additional Symptoms
      • Patient Examination
      • Physical Examination
      • Imaging Studies
      • Electrophysiological Studies
      • Behavioral Evaluation
      • Speech Evaluation
      • Additional Tests
      • Microsurgical Management Strategies of Facial Paralysis
      • Acute Post-Traumatic Facial Paralysis
      • Primary Nerve Repair
      • Interposition Nerve Grafts
      • Late FP
      • Cross-Facial Nerve Grafting (CFNG)
      • Denervation Time of Less Than 6 Months
      • Denervation Time of 6-27 Months ("Babysitter" Procedure)
      • Denervation Time Over 27 Months (Muscle Substitution)
      • Upper Face Reanimation (Eye).
      • Middle Face Reanimation.
      • Lower Face Reanimation.
      • Surgical Techniques
      • Cross-Facial Nerve Grafting
      • Direct Muscle Neurotization
      • Other Nerve Transfers
      • The Babysitter Procedure
      • Accessory Nerve Transfer
      • C7 Nerve Root Transfer
      • Eye
      • Static Procedures
      • Gold Weight
      • Palpebral Spring
      • Minitendon
      • Orbicularis Oculi Muscle (OOM) Substitution
      • Frontalis for Eye Sphincter Substitution
      • Platysma for Orbicularis Oculi Substitution
      • Temporalis for Eye Reanimation
      • Smile
      • Gracilis
      • Pectoralis Minor
      • Temporalis to Augment Smile
      • Platysma for Oral Sphincter Restoration
      • Depressor
      • Minihypoglossal to Cervicofacial Nerve Transfer
      • Platysma Transfer
      • Digastric Transfer
      • Tongue Movement and Bulk
      • Revisions
      • Postoperative Rehabilitation
      • Discussion
      • Conclusions
      • References
      • 16 Breast Reconstruction
      • Introduction
      • Anatomy of the Breast
      • Preoperative Considerations
      • Indications for Autologous Reconstruction
      • Preoperative Imaging
      • Computerized Tomographic Angiography
      • Magnetic Resonance Angiography
      • Duplex Ultrasound
      • Intraoperative Assessment and Monitoring Tools
      • Fluorescent Angiography
      • Surgical Procedures
      • Abdomen
      • DIEP Flap (see Ch. 57)
      • Free TRAM Flap (see Ch. 37)
      • SIEA Flap (see Ch. 57)
      • Pedicle TRAM Flap (see Ch. 37)
      • Posterior Thorax
      • Latissimus Dorsi Flap (see Ch. 41)
      • Thoracodorsal Artery Perforator Flap (TDAP) (see Ch. 58)
      • Gluteal Flaps (see Chs 44 and 58)
      • SGAP/IGAP Flaps (see Ch. 58)
      • Medial Thigh Flaps (see Ch. 49)
      • Posterior Thigh Flaps
      • Postoperative Considerations
      • Postoperative Recovery
      • Near Infrared Spectroscopy
      • Complications
      • Abdomen
      • Posterior Thorax
      • Gluteal Flaps
      • Posterior Thigh
      • Outcome Analysis
      • Conclusions
      • References
      • 17 Chest and Back Reconstruction
      • Introduction
      • Preoperative Considerations
      • Indications
      • Reconstruction by Region
      • Anterolateral Chest
      • Pectoralis Major
      • Coverage:
      • Advancement/Island Flap
      • Turnover Flap
      • Rectus Abdominis
      • Coverage:
      • Omentum
      • Coverage:
      • Latissimus Dorsi
      • Coverage:
      • Serratus Anterior
      • Coverage:
      • External Oblique
      • Coverage:
      • Intercostal Perforator Flap
      • Coverage:
      • Scapular/Parascapular
      • Coverage:
      • Trapezius
      • Coverage:
      • Intrathoracic
      • Posterior Torso
      • Trapezius
      • Coverage:
      • Latissimus Dorsi
      • Coverage:
      • Paraspinous (Erector Spinae) Muscle
      • Coverage:
      • Intercostal
      • Coverage:
      • External Oblique
      • Coverage:
      • Omentum
      • Coverage:
      • Lumbar Perforator
      • Coverage:
      • Postoperative Considerations
      • Complications
      • Recipient Site Complications
      • Donor Site Complications
      • Outcomes
      • References
      • 18 Abdominal Wall Reconstruction
      • Introduction
      • Indications
      • Preoperative Considerations
      • Patient Evaluation
      • Overview of Reconstruction by Region
      • Local Flap Options
      • Regional Flap Options
      • Free Flap Options
      • Recipient Vessels
      • Postoperative Considerations
      • Complications
      • Outcomes
      • References
      • 19 Pelvic and Urogenital Reconstruction
      • Introduction
      • Anatomy
      • Gender-Nonspecific Anatomy
      • Pertinent Male Anatomy
      • Pertinent Female Anatomy
      • Preoperative Considerations
      • Indications
      • Reconstruction by Region
      • Phalloplasty
      • General Principles of Total Phalloplasty
      • Described Locoregional and Pedicled Flaps
      • Described Free Tissue Flaps
      • The Key Steps for Microvascular Phalloplasty
      • Recipient Neurovascular Structures
      • Local Tissue Used for Reconstruction
      • Flap Design
      • Urethroplasty
      • Prelamination Method
      • Immediate Reconstruction with a Tube-in-Tube Design
      • Immediate Reconstruction with a Vascularized Flap
      • Delayed Reconstruction
      • Tubed Skin Graft
      • Creation of a Neourethral Plate and Tubularization at a Subsequent Stage
      • Glansplasty
      • Implantable Penile Prosthesis
      • Timing of Phalloplasty for Congenital Cases
      • Radial Forearm Free Flap Phalloplasty
      • Flap Characteristics
      • Neurovascular Structures
      • Flap Size and Design
      • Advantages
      • Disadvantages
      • Anterolateral Thigh Flap
      • Pedicle
      • Advantages
      • Disadvantages
      • Free Fibular Phalloplasty
      • Neurovascular Structures
      • Advantages
      • Disadvantages
      • Postoperative Considerations after Total Phalloplasty
      • Complications
      • Outcomes
      • Vulvar and Vaginal Reconstruction
      • General Principles
      • Neurovascular Pudendal Thigh Flap: Singapore Flap
      • Indications
      • Design/Pedicle
      • Technique
      • Advantages
      • Disadvantages
      • Bilateral Gracilis
      • Indications
      • Design/Pedicle
      • Technique
      • Advantages
      • Disadvantages
      • Pedicled Anterolateral Thigh Flap
      • Indications
      • Technique
      • Advantages
      • Disadvantage
      • Vertical Rectus Abdominus Myocutaneous
      • Indications
      • Design/Pedicle
      • Advantages
      • Disadvantages
      • Intestinal Vaginoplasty
      • Technique
      • Advantages
      • Disadvantages
      • Vulvar Reconstruction
      • Postoperative Considerations after Vaginoplasty
      • Complications
      • Outcomes
      • Perineal and Pelvic Floor Reconstruction
      • General Principles
      • Complications
      • Outcomes
      • Acknowledgments
      • References
      • 20 Upper Extremity Reconstruction
      • Introduction
      • Preoperative Considerations
      • Reconstruction by Region
      • Finger Soft Tissue Reconstruction
      • Distal Fingertip Reconstruction
      • The Volar V-Y Advancement (Atasoy or Kleinart) Flap
      • Distal Fingertip Transverse and Oblique Defect Reconstruction
      • Lateral V-Y Advancement (Kutler) Flaps
      • Distal Thumb Reconstruction
      • The Volar Advancement (Moberg) Flap
      • Volar and Dorsal Digit Reconstruction
      • The Cross Finger Flap
      • Distal Fingertip Reconstruction
      • The Thenar Crease Flap
      • Fingertip and Distal Finger Reconstruction
      • Homodigital and Heterodigital Flaps
      • The Thoraco-Epigastric Flap
      • The Free Toe Pulp Flap
      • Volar and Dorsal Finger Reconstruction
      • The Dorsal Metacarpal Artery Flap
      • Dorsal and Palmar Hand Defect Reconstruction
      • First Web Space Soft Tissue Defect Reconstruction
      • Elbow and Proximal Forearm Soft Tissue Defect Reconstruction
      • Postoperative Considerations
      • Complications
      • Outcomes
      • Conclusion
      • Further Reading
      • 21 Adult Brachial Plexus Injury (A-BPI) Reconstruction
      • Introduction
      • Consensus in Levels of Adult Brachial Plexus Injury
      • Management of Adult Brachial Plexus Injury
      • Consensus in Timing of Brachial Plexus Exploration
      • Clinical Presentation and Examination
      • Patient History
      • Patient Examination
      • Motor Examination
      • Sensory Examination
      • Vascular Injury Examination
      • Root Injury Pain
      • Plain X-Ray and Imaging Studies (MRI and/or CT)
      • Electrodiagnosis
      • Surgical Treatment
      • Exploration of the Supraclavicular Brachial Plexus
      • Exploration of the Infraclavicular Brachial Plexus
      • Surgical Strategies
      • Level I Injury
      • Nerve Transfer
      • Extraplexus Nerve Transfer
      • Intraplexus Nerve Transfer
      • Distal Nerve Transfer
      • Reconstructive Strategies with Nerve Transfers for Different Functions
      • Shoulder
      • Elbow
      • Finger
      • Functioning Free Muscle Transplantation
      • Level II Injury
      • Level III Injury
      • Level IV Injury
      • Postoperative Management and Rehabilitation
      • Palliative Reconstruction for Sequelae Deformities
      • Results and Outcomes
      • Shoulder
      • Elbow
      • Hand
      • Conclusion
      • References
      • 22 Lower Extremity Reconstruction
      • Introduction
      • Preoperative Considerations
      • Etiology of Defect
      • Traumatic
      • Oncologic
      • Diabetic, Vascular, or Lymphatic Etiology
      • Infectious Post-Debridement
      • Level of Defect
      • Indications
      • Traumatic Indications for Surgery
      • Salvage Versus Amputation
      • Surgical Objectives in the Acute Setting
      • Vascular Integrity
      • Debridement and Timing of Soft Tissue Reconstruction
      • Nerve Reconstruction
      • Bony Restoration
      • Soft Tissue Coverage
      • Proceeding with Amputation but Preserving Length
      • Oncologic Indications
      • Diabetic, Vascular, or Lymphatic Indications
      • Reconstruction by Region
      • Thigh Reconstruction
      • Bone Reconstruction at the Thigh Level
      • Soft Tissue Reconstruction at the Thigh Level
      • Knee Defect Reconstruction
      • Bone Reconstruction at the Knee
      • Soft Tissue Reconstruction at the Knee
      • Leg Reconstruction: Upper-Third, Middle-Third, Distal-Third
      • Bone
      • Soft Tissue Reconstruction in the Upper-Third Leg
      • Soft Tissue Reconstruction in the Middle-Third Leg
      • Soft Tissue Reconstruction in the Lower-Third Leg (Including Ankle)
      • Compartmental Defects of the Leg: Immediate FFMT
      • Propeller Flaps
      • Foot Reconstruction
      • Bone
      • Postoperative Considerations
      • Postoperative Protocol
      • Oncologic Reconstruction Postoperative Considerations
      • Traumatic Reconstruction Postoperative Considerations
      • Expected Secondary Challenges
      • Secondary Surgery after Traumatic Reconstruction
      • Nerve Dysfunction and Tendon Transfers.
      • Contracture Release and Functional Restoration.
      • Non-union and Chronic Osteomyelitis.
      • Vascular Challenges in Free Tissue Transfer.
      • Other Tools
      • Negative Pressure Wound Therapy
      • Complications
      • Trauma
      • Oncologic
      • Diabetic
      • Vascular
      • Lymphedema
      • Outcomes
      • Trauma
      • Psychiatric
      • Neurologic
      • Physical Therapy and Rehabilitation Services
      • Diabetic
      • Vascular
      • Lymphedema
      • Oncologic
      • References
      • 23 Functional Muscle Transfers for Various Purposes
      • Introduction
      • Functional Lower Lip Reconstruction Utilizing the Free Innervated Gracilis Muscle Flap (CASE 1)
      • Preoperative Considerations
      • Indications
      • Technique
      • Postoperative Considerations
      • Complications
      • Outcomes
      • Discussion
      • Functional Abdominal Wall Reconstruction (CASE 2 and 3)
      • Preoperative Considerations
      • Indications
      • Technique
      • Postoperative Considerations
      • Complications
      • Outcomes
      • Functional Detrusor Myoplasty Utilizing the Latissimus Dorsi Muscle Flap (CASE 4)
      • Introduction
      • Preoperative Considerations
      • Technique
      • Postoperative Considerations
      • Outcomes
      • Neuromusculotendinous Transfer for the Treatment of Drop Foot (CASE 5)
      • Preoperative Considerations
      • Indications
      • Technique
      • Postoperative Considerations
      • Complications
      • Outcomes
      • References
      • A Microsurgery Techniques
      • 24 Nerves
      • Introduction and Historical Notes
      • Anatomical Considerations
      • Classification of Nerve Injury
      • Wallerian Degeneration and Neuroregeneration
      • Planning the Reconstruction
      • Timing of Nerve Repair/Reconstruction
      • Sensory Protection of Denervated Muscle
      • Principles of Nerve Repair
      • Equipment
      • Operative Considerations
      • Neurorrhaphy Techniques
      • Epineurial Suture
      • Perineurial Suture
      • Epiperineurial Combined Suture
      • Nerve Reconstruction
      • Primary Nerve Repair
      • Nerve Grafts
      • Conventional Sural Nerve Grafting
      • Interfascicular Nerve Grafting
      • Vascularized Nerve Grafting
      • Nerve Transfers
      • End-to-Side Nerve Transfers
      • Supercharge (or Reverse End-to-Side) Nerve Transfers
      • Conclusions
      • Acknowledgments
      • References
      • 25 Vessels
      • Introduction
      • Preparation of Recipient Vessels
      • Selection of Recipient Vessels
      • Choosing the Site of Anastomosis
      • Gross Trimming of the Adventitia
      • Assessing the Quality of the Recipient Vein and Artery
      • Recipient Vein
      • Recipient Artery
      • Management of Flap Vessels
      • Microsurgical Instruments
      • Suture Material
      • Coaptation Devices
      • Vessel Set-Up for Suturing
      • Suturing Techniques
      • End-to-End Anastomosis
      • End-to-Side Anastomosis
      • Techniques for Use in Vessel Size Discrepancy
      • Suture Techniques
      • Correct Position of the Hand
      • Dealing with Discrepancy in Vessel Wall Thickness
      • Suturing a Vertically Oriented Anastomosis
      • Performing a Flow-Through Anastomosis
      • Performing Vein Grafts
      • Success in Vein Grafts Starts with Harvesting the Vein Graft
      • Suturing Atherosclerotic Vessels
      • Suture Tying Techniques
      • Arteriovenous Vascular Loops
      • Supermicrosurgery
      • Conclusion
      • References
      • Further Reading
      • B Flap Handling and Technical Tips
      • 26 Thinning and Tailoring
      • Purposes of Skin Flap Surgery
      • Geometry of the Donor Site and the Flap
      • General Principles in Shaping and Molding a Flap
      • Free Flap Reconstruction
      • Pedicled Flap Reconstruction
      • Thinning of the Flap
      • Microdissection
      • Anatomy of the Intra-Adipose Vessel
      • Thinning of the Flap Without Using the Microdissection Technique
      • Specific Principles in Shaping and Molding a Flap Considering Intra-Adiposal Vessel Anatomy
      • Folding and Splitting a Flap
      • Microdissected Tailoring of the Flap
      • Precautions for Free Flap Surgery
      • References
      • 27 Avoiding Complications
      • Introduction
      • Failure of Planning
      • The Patient
      • Fitness for Anesthesia
      • Age
      • Systemic Disease
      • Tobacco Smoking
      • Defect
      • Site and Cause
      • Dimensions
      • Donor Flap
      • Site
      • Composition
      • Pedicle Length and Caliber
      • Donor Morbidity
      • Recipient Vessels
      • Access
      • Damaged Vessels
      • Number of Venous Anastomoses
      • Timing
      • Failure of Execution
      • The Surgeon
      • Operator Experience
      • Anesthetic Complications
      • Vessel Preparation
      • Recipient
      • Pedicle Tension and Torsion
      • Size Mismatch
      • Anastomotic Technique
      • Vascular Grafting
      • Intraoperative Thrombosis
      • Ischemia Reperfusion Injury and the No-Reflow Phenomenon
      • Failure of Postoperative Care
      • Monitoring
      • Vascular Compromise
      • Late Complications
      • References
      • 28 Flap Re-exploration and Salvage
      • Introduction
      • Recognition that There is a Problem
      • Preparing for a Re-Exploration
      • Preoperative Considerations
      • Equipment
      • Medications
      • Aspirin
      • Heparin
      • Dextran
      • Vasodilators
      • Thrombolytics
      • Operative Set-Up
      • Approach to a Compromised Flap
      • Intraoperatively: Immediately After Completion of the Anastomoses
      • Initial Inspection
      • Medical Optimization
      • ReAssessment
      • After Leaving the Operating Room: Within the First 12 Hours
      • Extrinsic Factors of Flap Compromise
      • Wound Bed Anatomy
      • Implanted Materials
      • Skin Closure and Tunneling
      • Hypovascularization Due to Systemic Factors
      • Dressings, Bandages, and External Compression
      • Hematomas
      • Intrinsic Factors of Flap Compromise
      • Arterial Spasm
      • Kinking and Twisting
      • Vascular Thrombosis
      • Streptokinase.
      • Urokinase.
      • Recombinant Tissue Plasminogen Activator.
      • At 12-48 Hours After Completion of the Reconstructive Procedure
      • Beyond 48 Hours
      • Specific Steps in Re-Exploration
      • Stripping the Pedicle
      • Opening the Anastomosis
      • Vessel Dilation
      • Compressing the Flap
      • Use of Fogarty Catheters
      • Use of Vascular Grafts
      • When One Should Use New Recipient Vessels
      • When to Abandon the Salvaging of a Flap
      • Conclusion
      • References
      • C Pre and Postoperative Management
      • 29 Postoperative Care
      • Introduction
      • Perioperative Risk Reduction
      • Prevention of Postoperative Cardiac Complications
      • Deep Vein Thrombosis/Pulmonary Embolism Prophylaxis
      • Pneumonia and Pulmonary Prophylaxis
      • Hyperglycemic Control
      • Wound Infection Prophylaxis
      • Smoking Cessation
      • Flap Monitoring
      • Clinical Assessment
      • External Doppler
      • Internal Doppler
      • Laser Doppler
      • Near Infrared Angiography
      • Pulse Oximetry
      • Photography
      • Surface Temperature
      • Cellular and Wireless Devices
      • Management of Surgical Complications
      • Surgical Exploration
      • Antithrombotic Therapy
      • Thrombolytic Therapy
      • Discharge Care
      • Conclusion
      • References
      • 30 Reconstructive Options Following Flap Failure
      • Introduction
      • Patient-Centered Decision-Making
      • Step One: Clinical Status of the Patient
      • Step Two: Root Cause Analysis of Flap Failure
      • Systemic Factors
      • Extraluminal Factors
      • Intraluminal Factors
      • Thrombophilia
      • Step Three: Characterize the Defect
      • Step Four: Assess the Recipient Vessels
      • Step Five: Examine Reconstructive Choices
      • Selected List of Microsurgical and Non-Microsurgical Options
      • Second Free Flap: Pearls from the First Free Flap Failure
      • System-Based Practice
      • Perioperative Management
      • Microsurgical Technique
      • Postoperative Management
      • Use of Adjunctive Treatments
      • Postoperative Pain Control
      • Postoperative Fluid Management
      • Postoperative Vasoactive Drug Use
      • Postoperative Anticoagulation
      • Anxiolytics
      • Postoperative Monitoring
      • Hyperbaric Oxygen
      • Communication and Leadership
      • Conclusions
      • References
      • 4 Conventional Workhorse Flaps
      • A Local and Free Flaps in the Head and Neck
      • 31 Local Flaps in the Head and Neck
      • Introduction
      • Forehead Flap
      • Introduction
      • Flap Anatomy (Fig. 31.2 and Figs 10.1, 10.4 and 10.5)
      • Arterial and Venous Supply of the Flap
      • Arterial Supply (Figs 10.4 and 10.5)
      • Dominant:
      • Venous Drainage (See Figs 10.4 and 10.5B)
      • Flap Innervation (Figs 31.2, 10.11)
      • Flap Design
      • Anatomic Landmarks (Case 31.1, Fig. 31.3)
      • General Thoughts About Flap Design
      • Flap Dimensions
      • Technique of Flap Harvest (Case 31.1, Fig. 31.3)
      • Donor Site Closure and Management
      • Flap Usage
      • Postoperative Care and Expected Outcomes
      • FAMM Flap
      • Introduction
      • Flap Anatomy (See Figs 10.4, 10.5)
      • Arterial and Venous Supply of the Flap (See Figs 10.4 and 10.5)
      • Arterial Supply of the Flap
      • Dominant:
      • Venous Drainage of the Flap (See Figs 10.4 and 10.5B)
      • Primary:
      • Flap Innervation
      • Flap Design
      • Anatomic Landmarks (Case 31.2, Fig. 31.4)
      • General Thoughts About Flap Design
      • Flap Designs for Particular Types of Reconstructions
      • Flap Dimensions
      • Technique of Flap Harvest (Case 31.2, Fig. 31.4)
      • Donor Site Closure and Management
      • Flap Usage
      • Postoperative Care and Expected Outcomes
      • Submental Flap
      • Introduction
      • Flap Anatomy (Fig. 31.2 and See Figs 10.4, 10.5)
      • Arterial and Venous Supply of the Flap
      • Arterial Supply of the Flap (See Figs 10.4 and 10.5)
      • Dominant:
      • Venous Drainage of the Flap (See Figs 10.4 and 10.5)
      • Primary:
      • Flap Innervation (Fig. 31.2 and See Fig. 10.11)
      • Flap Design
      • Anatomic Landmarks (Case 31.3, Fig. 31.5)
      • General Thoughts About Flap Design
      • Flap Designs for Particular Types of Reconstructions
      • Flap Dimensions
      • Technique of Flap Harvest (Case 31.3, Fig. 31.5)
      • Donor Site Closure and Management
      • Flap Usage
      • Postoperative Care and Expected Outcomes
      • Nasolabial Flap
      • Introduction
      • Flap Anatomy (Figs 31.2, 10.4 and 10.5)
      • Arterial and Venous Supply (See Figs 10.4, 10.5)
      • Dominant:
      • Flap Innervation (Figs 31.2 and 10.10)
      • Flap Design
      • Anatomic Landmarks (Case 31.4, Fig. 31.6)
      • General Thoughts About Flap Design
      • Flap Designs for Particular Reconstructions
      • Flap Dimensions
      • Technique of Flap Harvest (Case 31.4, Fig. 31.6)
      • Donor Site Closure and Management
      • Flap Usage
      • Postoperative Care and Expected Outcomes
      • Cervicofacial Flap
      • Introduction
      • Flap Anatomy (Fig. 31.2 and See Figs 10.4, 10.5, 10.10, 10.11)
      • Arterial and Venous Supply (See Figs 10.4, 10.5)
      • Dominant:
      • Facial Artery
      • Flap Innervation (Fig. 31.2 and See Fig. 10.10)
      • Flap Design
      • Anatomic Landmarks (Case 31.5, Fig. 31.7)
      • General Thoughts About Flap Design
      • Flap Designs for Particular Reconstructions
      • Flap Dimensions
      • Technique of Flap Harvest (See Case 31.5 and Fig. 31.7)
      • Donor Site Closure and Management
      • Flap Usage
      • Postoperative Care and Expected Outcomes
      • References
      • 32 Temporoparietal Fascia Flap
      • Introduction
      • Flap Anatomy (Figs 32.1, 32.2 and see Figs 10.1, 10.4, and 10.5)
      • Arterial Supply of the Flap (Figs 32.1, 32.2, 32.4 and Figs 10.4, 10.5)
      • Dominant:
      • Minor:
      • Minor:
      • Venous Drainage of the Flap (Fig. 32.2 and see Figs 10.4, 10.5)
      • Primary:
      • Secondary:
      • Secondary:
      • Flap Innervation (Fig. 32.6 and see Fig. 10.11)
      • Flap Components
      • Advantages
      • Disadvantages
      • Flap Design (Fig. 32.8)
      • Anatomic Landmarks
      • General Thoughts About Flap Design
      • Flap Dimensions
      • Rotation of Pedicled Flaps
      • Flap Markings (Figs 32.8, 32.9)
      • Patient Positioning
      • Preoperative Preparation
      • Anesthetic Considerations
      • Technique of Flap Harvest (Fig. 32.9)
      • Endoscopic-Assisted Harvest
      • Flap Modifications
      • Bilobed: TPFF with Deep Temporal Fascia
      • Temporal Calvareal Osteofascial Flap
      • Technical Tips to Optimize Outcomes and Avoid Complications
      • Flap Usage
      • Pedicled Flap
      • Free Flap
      • Atypical
      • Postoperative Care
      • Untoward Outcomes
      • Conclusions
      • References
      • B Local and Free Flaps in the Chest
      • 33 Supraclavicular Artery Flap
      • Introduction
      • Flap Anatomy (Figs 33.1 and 11.1)
      • Arterial Supply of the Flap
      • Dominant:
      • Venous Drainage of the Flap
      • Primary:
      • Flap Innervation
      • Sensory:
      • Motor:
      • Flap Components
      • Advantages
      • Disadvantages
      • Preoperative Preparation
      • Flap Design (Case 1 and 2)
      • Anatomic Landmarks
      • General Thoughts About Flap Design
      • Flap Dimensions
      • Skin Island Dimensions
      • Flap Markings (Case 1 and 2)
      • Patient Positioning
      • Anesthetic Considerations
      • Technique of Flap Harvest (Fig. 33.3, Cases 1 and 2)
      • Flap Modifications
      • Donor Site Closure and Management
      • Technical Tips to Optimize Outcomes and Avoid Complications
      • Flap Usage
      • Postoperative Care
      • General
      • Recipient Site
      • Esophageal Reconstruction Patients
      • Intraoral Reconstruction Patients
      • Donor Site
      • Outcomes
      • General
      • Untoward Outcomes
      • General
      • Recipient Site
      • Donor Site
      • Long-Term Outcomes
      • General
      • Recipient Site
      • Donor Site
      • Conclusions
      • Further Reading
      • 34 Pectoralis Major Flap
      • Introduction
      • Flap Anatomy (see Ch. 11 and Figs 11.1, 11.2, 11.3, 11.5, 11.8 and 11.9)
      • Arterial Supply of the Flap (Fig. 34.1 and Figs 11.1, 11.2, 11.3 and 11.5)
      • Dominant to the Clavicular Head:
      • Dominant to the Sternocostal Head:
      • Minor:
      • Minor Supplying the Sternocostal Portion:
      • Minor:
      • Venous Drainage of the Flap (see Fig. 11.6)
      • Primary:
      • Secondary:
      • Flap Innervation
      • Sensory:
      • Motor:
      • Flap Components
      • Advantages
      • Disadvantages
      • Preoperative Preparation
      • Flap Design
      • Anatomic Landmarks
      • General Thoughts About Flap Design
      • Special Considerations
      • Difference in Design, if Any, When Performing the Flap as Pedicled or Free
      • Flap Dimensions
      • Muscle Dimensions
      • Skin Island Dimensions
      • Flap Markings
      • Patient Positioning
      • Anesthetic Considerations
      • Technique of Flap Harvest
      • Sternocostal Head of the Pectoralis Major Muscle
      • Clavicular Head of the Pectoralis Major Muscle
      • Flap Modification/Flap Handling
      • Costomyocutaneous Flap
      • Osteomyocutaneous Flap
      • Tissue Expansion
      • Free Pectoralis Major Muscle or Myocutaneous Flap
      • Pedicled Pectoralis Flap Under the Clavicle
      • Muscle-Preserving Method of Flap Harvest
      • Reverse Flap/Turnover Flap
      • Sensory Flap
      • Multiple Skin Island Flap
      • Clavicular Head of the Pectoralis Major Muscle as a Functional Muscle Transfer
      • Extended Pedicle Flap
      • Clavicular Head Osteomusculocutaneous Flap
      • Extended Skin Island
      • Breast Shape Preserving
      • Donor Site Closure and Management
      • Technical Tips to Optimize Outcomes and Avoid Complications
      • Flap Usage
      • Flap Usage
      • Typical Indications for the Use of This Flap
      • Atypical Indications for the Use of This Flap
      • Postoperative Care
      • General
      • Recipient Site
      • Esophageal Reconstruction Patients
      • Functional Muscle Transfer Patients
      • Mandibular Reconstruction with Pedicled Osteomyocutaneous Flap
      • Donor Site
      • Outcomes
      • Expected Outcomes
      • General
      • Recipient Site
      • Donor Site
      • Untoward Outcomes
      • General
      • Recipient Site
      • Donor Site
      • Long-Term Outcomes
      • General
      • Recipient Site
      • Donor Site
      • Conclusions
      • References
      • 35 Deltopectoral Flap and Internal Mammary Artery Perforator Flap
      • Introduction
      • Flap Anatomy (see Figs 11.2, 11.3, 11.8 and 11.9)
      • Arterial Supply of the Flap (see Figs 11.2 and 11.3)
      • Dominant:
      • Minor:
      • Minor:
      • Minor:
      • Venous Drainage of the Flap (see Fig. 11.8)
      • Primary:
      • Secondary:
      • Secondary:
      • Flap Innervation (see Fig. 11.9)
      • Sensory:
      • Motor:
      • Flap Components
      • Advantages
      • Disadvantages
      • Preoperative Preparation
      • Flap Design
      • Anatomic Landmarks
      • General Thoughts about Flap Design
      • Angiosome Concept
      • Special Considerations
      • Difference in Design, If Any, When Performing the Flap as Pedicled or Free
      • Flap Dimensions
      • Skin Island Dimensions
      • Flap Markings
      • Patient Positioning
      • Anesthetic Considerations
      • Technique of Flap Harvest
      • Deltopectoral Island Flap
      • Split Deltopectoral Flap
      • L-Shaped Deltopectoral Flap
      • Two-Layered Deltopectoral Flap Provided by Skin Grafting the Undersurface
      • Fenestrated Flap
      • Free Microvascular Transfer of the Deltopectoral Flap
      • Flap Modification/Flap Handling
      • Sensate Flap
      • Extended Flap
      • Extended Arc of Rotation
      • Internal Mammary Artery Perforator Flap
      • Expanded Deltopectoral Flap
      • Simultaneous Ipsilateral Pectoralis Major Myocutaneous Flap and Deltopectoral Flap
      • Supraclavicular Extension of the Deltopectoral (DP), Cervicodeltopectoral (CDP), Cervicopectoral Flaps
      • Donor Site Closure and Management
      • Technical Tips to Optimize Outcomes and Avoid Complications
      • Flap Usage
      • Typical Indications for the Use of This Flap
      • Atypical Indications for the Use of This Flap
      • Postoperative Care
      • General
      • Donor Site
      • Outcomes
      • Expected Outcomes
      • General
      • Donor Site
      • Untoward/Unfavorable Outcomes
      • General
      • Donor Site
      • Long-Term Outcomes
      • General
      • Donor Site
      • Conclusion
      • References
      • Further Reading
      • C Local and Free Flaps in the Abdomen
      • 36 Omentum, Superior Epigastric, and External/Internal Oblique Flaps
      • Introduction
      • Omentum Flap
      • Flap Anatomy (Fig. 36.1, see also Ch. 38)
      • Arterial and Venous Supply of the Flap
      • Dominant:
      • Minor:
      • Venous Drainage of the Flap
      • Primary:
      • Secondary:
      • Flap Innervation
      • Sensory:
      • Motor:
      • Flap Components
      • Advantages
      • Disadvantages
      • Preoperative Preparation
      • Flap Design
      • Anatomic Landmarks (Fig. 36.2)
      • General Thoughts About Flap Design
      • Special Considerations
      • Difference in Design, if Any, When Performing the Flap as Pedicled or Free
      • Flap Dimensions
      • Omentum Dimensions
      • Flap Markings
      • Patient Positioning
      • Anesthetic Considerations
      • Technique of Flap Harvest (Figs 36.6, 36.7)
      • Laparoscopic Harvest
      • Flap Modification/Flap Handling
      • Special Instruments
      • Donor Site Closure and Management
      • Technical Tips to Optimize Outcomes and Avoid Complications
      • Flap Usage
      • Typical Indications for the Use of This Flap
      • Pedicled (see Cases 36.1, 36.2)
      • Free Flap
      • Atypical Indications for the Use of This Flap
      • Pedicled
      • Free Flap
      • Postoperative Care
      • General
      • Recipient Site
      • Donor Site
      • Outcomes
      • Expected Outcomes
      • Untoward Outcomes
      • Superior Epigastric Flap
      • Flap Anatomy (see Figs 11.2, 11.3, 11.8 and 11.9)
      • Arterial and Venous Supply of the Flap (see Figs 11.2 and 11.3)
      • Dominant:
      • Venous Drainage of the Flap (Fig. 11.8)
      • Primary:
      • Flap Innervation (Fig. 11.9)
      • Flap Components
      • Advantages
      • Disadvantages
      • Preoperative Preparation
      • Flap Design
      • Anatomic Landmarks
      • General Thoughts About Flap Design
      • Special Considerations
      • Difference in Design, if Any, When Performing the Flap as Pedicled or Free
      • Flap Dimensions
      • Skin Island Dimensions
      • Flap Markings (Fig. 36.3)
      • Patient Positioning
      • Anesthetic Considerations
      • Technique of Flap Harvest
      • Flap Modification/Flap Handling
      • Special Instruments
      • Donor Site Closure and Management
      • Technical Tips to Optimize Outcomes and Avoid Complications
      • Flap Usage
      • Typical Indications for the Use of This Flap
      • Pedicled
      • Postoperative Care
      • General
      • Recipient Site
      • Donor Site
      • Outcomes
      • Expected Outcomes
      • Untoward Outcomes
      • External Oblique Flap
      • Flap Anatomy (see Figs 11.2, 11.3, 11.8 and 11.9)
      • Arterial and Venous Supply of the Flap (Figs 11.2 and 11.3)
      • Dominant:
      • Dominant:
      • Venous Drainage of the Flap (Fig. 11.8)
      • Primary:
      • Primary:
      • Flap Innervation (Fig. 11.9)
      • Sensory:
      • Motor:
      • Flap Components
      • Advantages
      • Disadvantages
      • Preoperative Preparation
      • Flap Design (Fig. 36.4)
      • Anatomic Landmarks
      • General Thoughts About Flap Design
      • Special Considerations
      • Difference in Design, if Any, When Performing the Flap as Pedicled or Free
      • Flap Dimensions
      • Skin Island Dimensions
      • Muscle Dimensions
      • Bone Dimensions
      • Flap Markings
      • Patient Positioning
      • Anesthetic Considerations
      • Technique of Flap Harvest
      • Musculocutaneous Flap Design for Coverage of Chest Wall Defects (Based on Segmental Posterior Intercostal Arteries)
      • Musculo-osteo(-cutaneous) Flap Design for Reconstruction of Combined Mandibular and Intraoral Soft Tissue Defects, Possibly as Chimeric Flap
      • Flap Modification/Flap Handling
      • Special Instruments
      • Donor Site Closure and Management
      • Flap Usage
      • Typical Indications for the Use of This Flap
      • Pedicled (see Cases 36.3)
      • Free Flap
      • Atypical Indications for the Use of This Flap
      • Pedicled
      • Postoperative Care
      • General
      • Recipient Site
      • Donor Site
      • Outcomes
      • Expected Outcomes
      • Untoward Outcomes
      • Internal Oblique Flap
      • Flap Anatomy (see Figs 11.2, 11.3, 11.6, 11.8, 11.9, 11.10 and see Ch. 42)
      • Arterial and Venous Supply of the Flap (see Figs 11.2, 11.3 and 11.6)
      • Dominant:
      • Minor:
      • Venous Drainage of the Flap (see Figs 11.6 and 11.8)
      • Primary:
      • Secondary:
      • Flap Innervation (see Figs 11.9 and 11.10)
      • Sensory:
      • Motor:
      • Flap Components
      • Advantages
      • Disadvantages
      • Preoperative Preparation
      • Flap Design (Fig. 36.5)
      • Anatomic Landmarks
      • General Thoughts About Flap Design
      • Special Considerations
      • Difference in Design, if Any, When Performing the Flap as Pedicled or Free
      • Flap Dimensions
      • Skin Island Dimensions
      • Muscle Dimensions
      • Bone Dimensions
      • Flap Markings
      • Patient Positioning
      • Anesthetic Considerations
      • Technique of Flap Harvest
      • Musculo-osteo(-cutaneous) Flap Design for Reconstruction of Combined Mandibular and Enoral Soft Tissue Defects or Lower Extremity Defects, Possibly as Chimeric Flap
      • Pedicled Internal Oblique Flap Based on DCIA
      • Flap Modification/Flap Handling
      • Donor Site Closure and Management
      • Technical Tips to Optimize Outcomes and Avoid Complications
      • Flap Usage
      • Typical Indications for the Use of This Flap
      • Free Flap
      • Atypical Indications for the Use of This Flap
      • Pedicled
      • Postoperative Care
      • General
      • Recipient Site
      • Donor Site
      • Outcomes
      • Expected Outcomes
      • Untoward Outcomes
      • Conclusions
      • References
      • 37 Rectus Abdominis Flap
      • Introduction
      • Flap Anatomy (Figs 11.2, 11.3, 11.8, 11.9, 37.1 and 37.3)
      • Arterial Supply of the Flap (Figs 11.3 and 37.1)
      • Dominant:
      • Dominant:
      • Minor:
      • Minor:
      • Venous Drainage of the Flap (See Fig. 11.8)
      • Primary:
      • Primary:
      • Secondary:
      • Flap Innervation (See Fig. 11.9)
      • Sensory:
      • Motor:
      • Flap Components
      • Advantages
      • Disadvantages
      • Preoperative Preparation
      • Flap Design
      • Anatomic Landmarks (Fig. 37.2)
      • General Thoughts About Flap Design
      • Chest Wall and Breast Reconstruction
      • Superiorly Based Unipedicled Myocutaneous Flap
      • Superiorly Based Bipedicled Myocutaneous Flap
      • Free Myocutaneous Flap Based on the DIEA (See Ch. 57)
      • Other Reconstructions (Fig. 37.3)
      • Difference in Design, if Any, When Performing the Flap as Pedicled or Free
      • Flap Dimensions
      • Skin Island Dimensions: Lower Abdominal Skin Flap
      • Skin Island Dimensions: Vertical Skin Flap
      • Muscle Dimensions
      • Bone Dimensions
      • Flap Markings
      • Patient Positioning
      • Anesthetic Considerations
      • Technique of Flap Harvest (Fig. 37.4)
      • Superiorly Based Pedicled TRAM Flap
      • Muscle Flap
      • Free Flap
      • Perforator Flap (See Ch. 57)
      • Flap Modification/Flap Handling
      • Delay of the Flap
      • Thinning of the Cutaneous Portion of the Flap
      • Sensory Reinnervation of the Flap
      • Functional Muscle Transfer
      • Muscle-Sparing Flap
      • Pedicled Flaps Based on the DIEA
      • Harvest of the Transverse Superior Skin Island and the Submammary Portion of the Flap
      • Splitting of the Flap between the Lateral and Medial Row Perforators
      • The Rectus Flap with Vascularized Rib
      • Supercharged Flap (Superiorly or Inferiorly Based, Arteries or Veins)
      • Free Microvascular Transfer of the Rectus Flap Based on the Deep Superior Epigastric Artery
      • Pedicle Extension of the Superiorly Based Flap
      • Pedicle Extension of the Inferiorly Based Flap
      • Method of Rotation and Inset of a Superiorly Based or Inferiorly Based Flap
      • Donor Site Closure and Management
      • Technical Tips to Optimize Outcomes and Avoid Complications
      • Flap Usage
      • Pedicled - Indications
      • Free Flap - Indications
      • Variations of the Flap
      • Typical Indications
      • Pedicled Flap
      • Free Flaps
      • Atypical Indications
      • Pedicled Flap
      • Free Flap
      • Postoperative Care and Expected Outcomes
      • General
      • Recipient Site
      • Donor Site
      • Outcomes
      • Expected Outcomes
      • General
      • Breast Reconstruction
      • Donor Site
      • Untoward/Unfavorable Outcomes
      • General
      • Donor Site
      • Long-Term Outcomes
      • General
      • Breast Reconstruction
      • Donor Site
      • Conclusions
      • Further Reading
      • 38 Jejunum Flap
      • Introduction
      • Regional Anatomy
      • Small Intestine
      • Mesentery
      • Jejunum
      • Arterial Anatomy of the Region
      • Blood Supply of the Jejunum
      • Venous Anatomy of the Region
      • Nerves in the Region
      • Flap Anatomy
      • Arterial Supply of the Flap
      • Jejunal Artery
      • Venous Drainage of the Flap (Fig. 38.4)
      • Primary:
      • Flap Innervation
      • Sensory:
      • Motor:
      • Flap Components
      • Advantages
      • Disadvantages
      • Preoperative Preparation
      • Flap Design
      • Anatomic Landmarks
      • General Thoughts About Flap Design
      • Special Considerations
      • Jejunum as a Conduit (Case 38.2)
      • Jejunum as a Patch
      • Difference in Design, if Any, When Performing the Flap as Pedicled or Free
      • Flap Dimensions
      • Flap Markings
      • Patient Positioning
      • Anesthetic Considerations
      • Technique of Flap Harvest
      • Harvesting Jejunum as a Free Flap (Fig. 38.10)
      • Harvesting Jejunum as Pedicled Flap for Esophageal Reconstruction (Case 38.3)
      • Harvesting Pedicled Jejunal Flap for Vaginal Reconstruction (Case 38.4)
      • Flap Modifications/Flap Handling
      • Supercharging a Pedicled Jejunum (Case 38.3)
      • The Jejunum-Mesenteric Free Flap
      • A Free or Pedicled Jejunal Patch
      • Free Jejunum as a Diversionary Conduit for Swallowing
      • Jejunum for Voice Reconstruction
      • Special Instruments
      • Donor Site Closure and Management
      • Technical Tips to Optimize Outcomes and Avoid Complications
      • Flap Usage
      • Pedicled
      • Free Flap
      • Indications by Region
      • Typical Indications for the Use of This Flap
      • Esophageal Reconstruction
      • Reconstruction of the Cervical Esophagus or Hypopharynx Using Free Jejunum (Case 38.1)
      • Repair of Esophageal Stricture Using Free Jejunal Patch Flap
      • Reconstruction after Total Esophagectomy Using Pedicled Jejunum
      • Technical Steps for a Substernal Route
      • Technical Steps for the Subcutaneous Route.
      • After the Substernal or Subcutaneous Tunnel Has Been Made
      • Reconstruction of the Thoracic Esophagus with Pedicled Jejunum Interposition
      • Atypical Indications for the Use of This Flap
      • Pedicled Jejunum in the Treatment of Short Gut Syndrome
      • Vaginal Reconstruction (Case 38.4)
      • Urethral Reconstruction
      • Postoperative Care
      • General
      • Recipient Site
      • Use of a Monitoring Segment of Jejunum
      • Monitoring a Buried Jejunal Flap at Any Site, Pedicled or Free
      • Donor Site
      • Outcomes
      • Expected Outcomes
      • General
      • For Different Indications
      • Donor Site
      • Untoward Outcomes
      • General
      • Esophagus Reconstruction
      • Donor Site
      • Long-Term Outcomes
      • General
      • Conclusions
      • Further Reading
      • D Local and Free Flaps in the Back
      • 39 Trapezius Flap
      • Introduction
      • Regional Anatomy (Figs 39.1-39.4 and Figs 11.1, 11.4 and 11.7)
      • Arterial Anatomy of the Region (Figs 39.1-39.4 and Fig. 11.7)
      • Venous Anatomy of the Region
      • Nerves in the Region (Figs 39.1, 39.3, 39.4 and Fig. 11.7)
      • Flap Anatomy (Figs 39.1-39.7 and Fig. 11.7)
      • Arterial Supply of the Flap (Figs 39.1 and 39.2 and Fig. 11.7)
      • Trapezius Flap Based on the SCA
      • Dominant:
      • Minor:
      • Trapezius Flap Based on the DSA
      • Dominant:
      • Minor Pedicles:
      • Variation of Arterial Origin (Fig. 39.5, Table 39.1)
      • Venous Drainage of the Flap
      • Trapezius Flaps Based on the SCA and the DSA
      • Primary:
      • Flap Innervation (Figs 39.1, 39.3, 39.4 and Fig. 11.7)
      • Sensory:
      • Sensory:
      • Motor:
      • Flap Components
      • Trapezius Flap Based on the SCA
      • Trapezius Flap Based on the DSA
      • Advantages
      • Trapezius Flap Based on the SCA
      • Trapezius Flap Based on the DSA
      • Disadvantages
      • Trapezius Flap Based on the SCA
      • Trapezius Flap Based on the DSA
      • Preoperative Preparation
      • Flap Design
      • Anatomic Landmarks (Figs 39.8, 39.9)
      • Trapezius Flap Based on the SCA
      • Trapezius Flap Based on the DSA
      • General Thoughts About Flap Design
      • Trapezius Flap Based on the SCA
      • Trapezius Flap Based on the DSA
      • Special Considerations
      • Soft Tissue Defects of the Anterior Neck and Lower Face
      • Soft Tissue Defects, Including a Visceral Part, Such as Base of Tongue, Hypopharynx, or Esophagus
      • Osteocutaneous Defects of the Mandible and Overlying Soft Tissue
      • Soft Tissue Defects of the Midface and Orbital Region
      • Soft Tissue Defects of the Back (Including the Dorsal Spine), the Axilla, the Posterior Neck, and the Occipital Region
      • Soft Tissue Defects of the Middle and Lower Thoracic Spine Region
      • Difference in Design, if Any, When Performing the Flap as Pedicled or Free
      • Flap Dimensions
      • Trapezius Flap Based on the SCA
      • Skin Island Dimensions (Vertical and Transverse) (Fig. 39.10A,B)
      • Muscle Dimensions (Vertical and Transverse)
      • Bone Dimensions
      • Trapezius Flap Based on the DSA
      • Skin Island Dimensions (Fig. 39.10C)
      • Muscle Dimensions
      • Flap Markings (Figs 39.8-39.10)
      • Flaps Based on the SCA and DSA
      • Trapezius Flap Based on the SCA
      • Trapezius Flap Based on the DSA
      • Patient Positioning
      • Trapezius Flap Based on the SCA
      • Trapezius Flap Based on the DSA
      • Anesthetic Considerations
      • Technique of Flap Harvest
      • Trapezius Flaps Based on the SCA (Three Flap Types)
      • Pedicled Myocutaneous Flap Based on the Ascending (Superior) Branch of the SCA (Fig. 39.11)
      • Pedicled Osteomyocutaneous Flap Based on the Ascending (Superior) Branch of the SCA
      • Myocutaneous Flap Based on the Descending (Inferior) Branch of the SCA
      • Trapezius Flap Based on the DSA
      • Flap Modification/Flap Handling
      • Extended Trapezius Myocutaneous Flap
      • Trapezius Muscle Flap
      • Trapezius Muscle Turnover Flap
      • Functional Muscle Transfer
      • Donor Site Closure and Management
      • Flaps Based on the Ascending Branch of the SCA
      • Flaps Based on the Descending Branch of the SCA or on the DSA
      • Technical Tips to Optimize Outcomes and Avoid Complications
      • Flap Usage
      • Pedicled
      • Head and Neck
      • Based on the Ascending Branch of the SCA
      • Myocutaneous with a Transverse Skin Island
      • Osteomyocutaneous with a Transverse Skin Island
      • Based on the Descending Branch of the SCA
      • Myocutaneous with a Vertical or Transverse Island
      • Based on the DSA
      • Myocutaneous with a Vertical Island
      • Trunk
      • Based on the DSA
      • Myocutaneous with a Vertical Skin Island
      • Based on the Intercostal Segmental Arteries
      • Muscle Flap Only
      • Free Flap
      • Myocutaneous Flaps Based on the SCA or DSA
      • Flap Usage
      • Typical Indications for This Flap
      • Pedicled Flaps Based on the Ascending Branch of the SCA
      • Pedicled Flaps Based on the Descending Branch of the SCA
      • Pedicled Flaps Based on the DSA
      • Atypical Indications for This Flap
      • Free Flaps Based on the DSA or SCA
      • Postoperative Care
      • General
      • Recipient Site
      • Donor Site
      • Outcomes
      • Expected Outcomes
      • General
      • Flaps Based on the Ascending Branch of the SCA
      • Flaps Based on the Descending Branch of the SCA and on the DSA
      • Donor Site
      • Untoward Outcomes
      • General
      • Donor Site
      • Long-Term Outcomes
      • General
      • Conclusions
      • References
      • Further Reading
      • 40 Scapular and Parascapular Flaps
      • Introduction
      • Flap Anatomy (Figs 40.1, 40.2, 40.3 and see Figs 11.1, 11.3, 11.4)
      • Arterial Supply of the Flap (Figs 40.1, 40.2, 40.3 and See Figs 11.1, 11.4)
      • Scapular Cutaneous Flap
      • Dominant:
      • Minor:
      • Parascapular Cutaneous Flap
      • Dominant:
      • Scapular Bone Flap
      • Dominant:
      • Scapular Tip Bone Flap
      • Dominant:
      • Venous Drainage of the Flap
      • Scapular and Parascapular (Cutaneous, Osteocutaneous, and Osseous) Flaps
      • Primary:
      • Secondary:
      • Scapular Tip Bone Flap
      • Flap Innervation
      • Sensory (see Figs 11.7, 11.9):
      • Motor:
      • Flap Components
      • Advantages
      • Disadvantages
      • Preoperative Preparation
      • Flap Design
      • Flap Markings (Fig. 40.4)
      • Anatomic Landmarks and Markings (Fig. 40.4 and See Figs 11.4 and 11.7)
      • General Thoughts About Flap Design
      • Special Considerations
      • Difference in Design, if Any, When Performing the Flap as Pedicled or Free
      • Flap Dimensions
      • Scapular Flap
      • Skin Island Dimensions
      • Parascapular Flap
      • Skin Island Dimensions
      • Bone
      • Lateral Scapula Bone
      • Medial Scapula Bone
      • Scapular Tip (Angle of Scapula)
      • Patient Positioning
      • Anesthetic Considerations
      • Technique of Flap Harvest (Fig. 40.5)
      • Flap Modification/Flap Handling
      • Thinned Scapular or Parascapular Flap
      • Delayed Flap
      • Tissue Expanded Flap
      • Osteocutaneous Flaps (see Case 40.1)
      • Lateral Scapular Bone Flap
      • Medial Scapula Bone Flap
      • Scapular Tip Bone Flap Based on the Angular Artery (Fig. 40.6)
      • Chimeric Flap
      • Fascial Flap
      • Donor Site Closure and Management
      • Technical Tips to Optimize Outcomes and Avoid Complications
      • Flap Usage
      • Pedicled
      • Free Flap
      • Head and Neck
      • Trunk
      • Upper Extremity
      • Lower Extremity
      • Typical Indications for the Use of This Flap
      • Atypical Indications for the Use of This Flap
      • Cranial Reconstruction
      • Postoperative Care
      • General
      • Recipient Site
      • Donor Site
      • Outcomes
      • Expected Outcomes
      • General
      • Untoward Outcomes
      • Donor Site
      • Long-Term Outcomes
      • Donor Site
      • Conclusions
      • References
      • Further Reading
      • 41 Latissimus Dorsi Flap
      • Introduction
      • Flap Anatomy (Figs 41.1, 41.2 and Figs 11.1, 11.2, 11.3, 11.4, 11.5 and 11.7, 11.8 and 11.9)
      • Arterial Supply of the Flap (Figs 41.1, 41.2 and Figs 11.1 and 11.5)
      • Dominant:
      • Minor:
      • Venous Drainage of the Flap (Fig. 11.8)
      • Primary:
      • Secondary:
      • Flap Innervation (Fig. 41.1, and Figs 11.1, 11.7, 11.9)
      • Sensory:
      • Motor:
      • Flap Components
      • Advantages
      • Disadvantages
      • Preoperative Preparation
      • Flap Design
      • Anatomic Landmarks (Fig. 41.3)
      • General Thoughts About Flap Design
      • Special Considerations
      • Breast Reconstruction
      • Head and Neck Reconstruction
      • Soft Tissue Defect of the Lower Extremity with a Bone Defect
      • Difference in Design, if Any, When Performing the Flap as Pedicled or Free
      • Pedicled Flap
      • Free Flap
      • Flap Dimensions
      • Muscle Dimensions
      • Skin Island Dimensions
      • Bone Dimensions
      • Flap Markings (Fig. 41.4)
      • Patient Positioning
      • Anesthetic Considerations
      • Technique of Flap Harvest (Fig. 41.5)
      • Latissimus Muscle or Myocutaneous Flap Pedicled Transfer for Breast or Chest Wall Reconstruction
      • Free Microvascular Transfer for Distant Reconstruction
      • Flap Modification/Flap Handling
      • Enlarged Flap
      • Reverse Flap
      • Extended Flap
      • Bilobed Split Latissimus Dorsi Flap
      • Thoracodorsal Artery Perforator (TDAP) Flap
      • Rib-Latissimus Dorsi Osteomusculocutaneous Flap
      • Thinned Muscle Flap
      • Special Instruments
      • Donor Site Closure and Management
      • Technical Tips to Optimize Outcomes and Avoid Complications
      • Flap Usage
      • Pedicled
      • Arc of Rotation
      • Free Flap
      • Head and Neck
      • Trunk
      • Upper Extremity
      • Lower Extremity
      • Typical Indications for the Use of This Flap
      • Pedicled Flap
      • Anterior Arc
      • Posterior Arc
      • Free Flap
      • Atypical Indications for the Use of This Flap
      • Pedicled Transfer
      • Free Microvascular Transfer
      • Postoperative Care
      • General
      • Recipient Site
      • Donor Site
      • Outcomes
      • Expected Long-Term Outcomes
      • Untoward Outcomes
      • Donor Site
      • Conclusions
      • References
      • Further Reading
      • E Local and Free Flaps in the Pelvis, Groin, and Buttock
      • 42 Iliac Flap
      • Introduction
      • Flap Anatomy (see Fig. 42.1 and Figs 11.3, 11.6, 11.8, 11.9 and 11.10)
      • Arterial Supply of the Flap (see Fig. 42.1 and Figs 11.6, 11.9 and 11.10)
      • Dominant:
      • Common Anatomic Variants
      • Minor:
      • Venous Drainage of the Flap (See Figs 11.6, 11.8)
      • Primary:
      • Secondary:
      • Flap Innervation (See Fig. 42.1, and Figs 11.9 and 11.10)
      • Sensory:
      • Motor:
      • Flap Components
      • Advantages
      • Disadvantages
      • Preoperative Preparation
      • Flap Design
      • Anatomic Landmarks (Figs 42.2, 42.3)
      • General Thoughts About Flap Design
      • Special Considerations
      • Flap Design Based on Recipient Requirements
      • Difference in Design, if Any, When Performing the Flap as Pedicled or Free
      • Flap Dimensions
      • Skin Island Dimensions
      • Muscle Dimensions
      • Bone Dimensions
      • Flap Markings (Fig. 42.3)
      • Patient Positioning
      • Anesthetic Considerations
      • Technique of Flap Harvest (Figs 42.4-42.6)
      • Flap Harvest Without Internal Oblique
      • Shaping of the Neo-Mandible
      • Flap Modification/Flap Handling
      • Bone Component
      • "Split" Iliac Crest
      • Multiple Segment Osteotomies of the Iliac Bone
      • Muscular Component
      • Iliac Crest with Internal Oblique and Perforator Skin and Iliac Crest with Internal Oblique
      • Skin Component
      • Supercharging the Skin Island with Inflow From the SCIA
      • Perforator-Based Osteomyocutaneous or Osteocutaneous Flap
      • Donor Site Closure and Management (Fig. 42.6)
      • Technical Tips to Optimize Outcomes and Avoid Complications
      • Flap Usage
      • Free Flap
      • Head and Neck
      • Upper Extremity
      • Lower Extremity
      • Typical Indications for the Use of This Flap
      • Free Microvascular Transfer of the Iliac Flap
      • Atypical Indications for the Use of This Flap
      • Pedicled Bone Flaps for Hip Reconstruction
      • Postoperative Care
      • General
      • Recipient Site
      • Donor Site
      • Outcomes
      • Expected Outcomes
      • General
      • Donor Site
      • Untoward Outcomes
      • General
      • Donor Site
      • Long-Term Outcomes
      • General
      • Donor Site
      • Conclusions
      • Mandibular Reconstruction
      • Maxillary Reconstruction
      • References
      • Further Reading
      • 43 Groin Flap and Superficial Circumflex Iliac Artery Perforator Flap
      • Introduction
      • Flap Anatomy
      • Arterial Supply of the Flap (see Figs 43.1 and 43.2 and Figs 11.3, 11.6, 11.8, 11.9 and 11.10)
      • Dominant:
      • Venous Drainage of the Flap (see Fig. 43.2 and Figs 11.6 and 11.8)
      • Primary:
      • Secondary:
      • Flap Innervation (Figs 43.1 and 11.10)
      • Sensory:
      • Motor:
      • Flap Components
      • Advantages
      • Groin Flap and SCIP Flap
      • SCIP Flap
      • Disadvantages
      • Groin Flap and SCIP Flap
      • SCIP Flap
      • Preoperative Preparation
      • Flap Design (Fig. 43.3)
      • Anatomic Landmarks
      • General Thoughts About Flap Design
      • Special Considerations
      • Differences in Design, if Any, When Performing the Flap as Pedicled or Free
      • Flap Dimensions
      • Skin Island Dimensions
      • Muscle Dimensions
      • Bone Dimensions
      • Flap Markings (Fig. 43.3)
      • Groin and SCIP Flap
      • SCIP Flap
      • Patient Positioning
      • Anesthetic Considerations
      • Technique of Flap Harvest
      • Groin Flap (Fig. 43.4)
      • Pedicled Groin Flap
      • Free Groin Flap (Fig. 43.5)
      • SCIP Flap (Fig. 43.2)
      • Flap Modification/Flap Handling
      • Thin SCIP Flap
      • SCIP Flap with Additional Adipose Tissue
      • Combined SCIP-Anterolateral Thigh (Alt) Flap (Fig. 43.6)
      • Combined SCIP or Groin Flap with Vascularized Iliac Bone Graft Based on the DCIA (Fig. 43.7)
      • SCIP Osteocutaneous Flap
      • Special Instruments
      • Donor Site Closure and Management
      • Technical Tips to Optimize Outcomes and Avoid Complications
      • Flap Usage
      • Pedicled
      • Free Flap
      • Typical Indications for the Use of This Flap
      • Pedicled Tubed Groin Flap or SCIP Flap for Upper Extremity Reconstruction
      • Free Groin or SCIP Flap for Soft Tissue Coverage or as a Buried Flap for Soft Tissue Augmentation
      • Pedicled Groin or SCIP Flap for Abdominal Wall or Perineal Reconstruction
      • Atypical Indications for the Use of This Flap
      • Free Groin Lymph Node Transfer for Upper or Lower Extremity Lymphedema
      • Pedicled SCIP Flap for Penile Reconstruction
      • Free Skin Aponeurosis for Reconstruction of a Soft Tissue Defect and Underlying Tendon
      • Postoperative Care
      • General
      • Recipient Site
      • Donor Site
      • Outcomes
      • Expected Outcomes
      • General
      • Donor Site
      • Untoward Outcomes
      • General
      • Donor Site
      • Long-Term Outcomes
      • General
      • Donor Site
      • SCIP Flaps
      • Conclusions
      • Acknowledgments
      • Further Reading
      • 44 Gluteus Flap
      • Introduction
      • Flap Anatomy
      • Arterial Supply of the Flap (See Fig. 58.1 and Fig. 13.3)
      • Dominant:
      • Dominant:
      • Minor:
      • Venous Drainage
      • Primary:
      • Primary:
      • Secondary:
      • Flap Innervation
      • Sensory (See Figs 13.3 and 58.1):
      • Motor:
      • Flap Components
      • Advantages
      • Disadvantages
      • Advantages of Gluteal Perforator Flaps Over Gluteus Maximus Muscle Flaps
      • Preoperative Preparation
      • Flap Design
      • Anatomic Landmarks (see Fig. 44.2)
      • General Thoughts About Flap Design
      • Special Considerations
      • Sgap Free Flap for Breast Reconstruction
      • Sgap Pedicled Flap for Pelvic Reconstruction
      • Flap Dimensions
      • Skin Island Dimensions
      • Muscle Dimensions
      • Flap Markings
      • Patient Positioning
      • Anesthetic Considerations
      • Technique of Flap Harvest
      • Free Flap
      • Sgap Free Flap
      • Superior Gluteus Maximus Muscle Free Flap
      • Inferior Gluteal Artery Perforator Free Flap
      • Inferior Gluteus Maximus Musculocutaneous Free Flap
      • Pedicled Flap
      • Pedicled Gluteal Perforator Flaps
      • Pedicled Musculocutaneous Flap
      • Flap Modification/Flap Handling
      • Perforator Flap
      • Gluteus Maximus Muscle Flap
      • Gluteal Thigh Flap
      • Donor Site Closure and Management
      • Technical Tips to Optimize Outcomes and Avoid Complications
      • Free Flaps
      • Pedicled Flaps
      • Flap Usage
      • Perforator Flap
      • Pedicled Gluteus Maximus Flaps
      • Typical Indications for the Use of this Flap
      • Pedicled Flap
      • Sacral Defects.
      • Dorsal Lower Trunk Defects.
      • Free Flap
      • Breast Reconstruction.
      • Atypical Indications for the Use of this Flap
      • Ischial and Trochanteric Defects
      • Postoperative Care
      • General
      • Outcomes
      • Expected Outcomes
      • General
      • Untoward Outcomes
      • General
      • Donor Site
      • Long-Term Outcomes
      • General
      • Donor Site
      • Conclusion
      • References
      • Further Reading
      • F Local and Free Flaps in the Upper Extremity
      • 45 Pedicled Flaps of the Hand
      • Introduction
      • First Dorsal Metacarpal Artery Flap
      • Flap Anatomy (Fig. 45.1 and See Figs 12.20, 12.21, 12.22)
      • Dominant Pedicle:
      • Minor Pedicle:
      • Venous Drainage (See Figs 12.18 and 12.22)
      • Primary:
      • Secondary:
      • Flap Innervation (Fig. 45.1 and See Figs 12.20, 12.22)
      • Flap Components: Skin and Subcutaneous Tissue
      • Advantages
      • Disadvantages
      • Flap Design (Cases 45.1, 45.2)
      • Flap Dimensions
      • Anesthetic Considerations:
      • Technique of Harvest
      • Donor Site Closure
      • Indications:
      • Postoperative Care and Outcomes
      • Cross Finger Flap
      • Flap Anatomy (Fig. 45.1 and See Figs 12.20, 12.21, 12.22)
      • Dominant Pedicle:
      • Venous Drainage (See Figs 12.16, 12.22)
      • Flap Innervation
      • Flap Components
      • Advantages
      • Disadvantages
      • Preoperative Preparation
      • Flap Design (Cases 45.3, 45.4)
      • Flap Dimensions
      • Flap Markings
      • Anesthetic Considerations
      • Technique of Harvest
      • Flap Handling
      • Flap Modification
      • Outcomes
      • Moberg Flap
      • Flap Anatomy (See Figs 12.17 and 21.22)
      • Dominant Arterial Pedicle:
      • Venous Drainage (See Fig. 12.10):
      • Innervation (See Fig. 12.10):
      • Advantages
      • Disadvantages
      • Preoperative Preparation
      • Flap Design (Cases 45.5, 45.6)
      • Flap Dimensions
      • Anesthesia Considerations
      • Technique of Harvest
      • Flap Handling
      • Donor Site Closure
      • Outcomes
      • The Homodigital Island Flap
      • Flap Anatomy (See Figs 12.17, 12.20, 12.21, 12.22)
      • Dominant Pedicle:
      • Minor Pedicle:
      • Venous Drainage (See Fig. 12.22)
      • Primary:
      • Secondary:
      • Flap Innervation (See Figs 12.21 and 12.22)
      • Advantages
      • Disadvantages
      • Flap Dimensions
      • Skin Island Dimensions
      • Flap Markings
      • Patient Positioning
      • Anesthetic Considerations
      • Technique of Flap Harvest
      • Flap Modification/Flap Handling
      • Special Instruments
      • Technical Tips to Optimize Outcomes and Avoid Complications
      • Donor Site Closure
      • Flap Usage
      • Indications for Use of This Flap
      • Postoperative Care and Outcomes
      • Distal Ulnar Artery Perforator Flap
      • Flap Anatomy (See Figs 12.9, 12.10 and 12,22)
      • Dominant Pedicle:
      • Venous drainage (See Fig. 12.22):
      • Sensory innervation (See Fig. 12.22):
      • Advantages
      • Disadvantages
      • Preoperative Preparation
      • Flap Design
      • Flap Dimensions
      • Skin Island Dimensions
      • Technique of Harvest
      • Donor Site Closure
      • Atypical Indications for This Flap
      • Outcomes
      • The Posterior Interosseous Artery Flap
      • Flap Anatomy (See Figs 12.5, 12.14 and 12.22)
      • Dominant:
      • Venous Drainage
      • Primary:
      • Secondary:
      • Flap Innervation
      • Flap Components
      • Advantages
      • Disadvantages
      • Preoperative Preparation
      • Flap Design
      • Flap Dimensions
      • Skin Island Dimensions
      • Flap Markings
      • Patient Positioning
      • Anesthetic Considerations
      • Technique of Flap Harvest
      • Flap Modification/Flap Handling
      • Special Instruments
      • Donor Site Closure
      • Technical Tips to Optimize Outcomes and Avoid Complications
      • Flap Usage
      • Atypical Indications for Use of This Flap
      • Postoperative Care and Outcomes
      • Conclusion
      • References
      • Further Reading
      • First Dorsal Metacarpal Artery Flap
      • Cross Finger Flap
      • Moberg Flap
      • The Homodigital Island Flap
      • Distal Ulnar Artery Perforator Flap
      • The Posterior Interosseous Artery Flap
      • 46 Lateral Arm Flap
      • Introduction
      • Flap Anatomy (see Fig. 46.1 and Figs 12.4, 12.5, 12.22 and 12.23)
      • Arterial and Venous Supply of the Flap (Fig. 46.1 and Figs 12.4 and 12.5)
      • Dominant:
      • Minor:
      • Minor:
      • Venous Drainage of the Flap
      • Primary:
      • Secondary:
      • Flap Innervation (Figs 12.22 and 12.23)
      • Sensory:
      • Motor:
      • Flap Components
      • Advantages
      • Disadvantages
      • Preoperative Preparation
      • Flap Design
      • Anatomic Landmarks (Fig. 46.2)
      • General Thoughts about Flap Design
      • Special Considerations
      • Head and Neck Reconstruction
      • Extremity Reconstruction
      • Difference in Design, If Any, When Performing the Flap as Pedicled or Free
      • Flap Dimensions
      • Skin Island Dimensions
      • Lateral Arm Flap
      • Extended Lateral Arm Flap
      • Muscle Dimensions
      • Triceps Muscle
      • Brachialis Muscle
      • Brachioradialis Muscle
      • Bone Dimensions
      • Humerus
      • Tendon Dimensions
      • Triceps Tendon
      • Nerve Dimensions
      • Lower Brachial Cutaneous Nerve/Posterior Antebrachial Cutaneous Nerve
      • Flap Markings (Fig. 46.3)
      • Patient Positioning
      • Anesthetic Considerations
      • Technique of Flap Harvest
      • Lateral Arm Flap
      • Extended Lateral Arm Flap
      • Flap Modification/Flap Handling
      • Reverse Flap
      • Fascia and Adipofascia Flap
      • Osseofasciocutaneous Flap
      • Combined Musculotendinous and Fasciocutaneous Flap
      • Neurosensory Flap
      • Extended Pedicle Flap
      • Flow-Through Flap for Distal Revascularization
      • Split Cutaneous Flap
      • Special Instruments
      • Donor Site Closure and Management
      • Technical Tips to Optimize Outcomes and Avoid Complications
      • Flap Usage
      • Pedicled LAF/ELAF
      • Reverse LAF
      • Free LAF/ELAF
      • Typical Indications for the Use of this Flap
      • Pedicled LAF/ELAF
      • Soft Tissue Defects of the Shoulder and Axilla
      • Soft Tissue Defects of the Elbow Region
      • Free LAF/ELAF
      • Head and Neck
      • Upper and Lower Extremity
      • Atypical Indications for the Use of this Flap
      • Penile Reconstruction with a Free Fasciocutaneous LAF/ELAF
      • Postoperative Care and Expected Outcomes
      • General
      • Recipient Site
      • Donor Site
      • Outcomes
      • Expected Outcomes
      • Short-Term Outcomes
      • Recipient Site
      • Donor Site
      • Long-Term Outcomes
      • Recipient Site
      • Donor Site
      • Untoward Outcomes
      • Recipient Site
      • Donor Site
      • Conclusion
      • References
      • Further Reading
      • 47 Radial Forearm Flap
      • Introduction
      • Flap Anatomy (Figs 47.1 and 47.2, See Figs 12.8, 12.9, 12.10, 12.12, 12.19, 12.22, and 12.23)
      • Arterial Supply of the Flap (Figs 47.1 and 47.2 and Figs 12.8, 12.9 and 12.10)
      • Dominant (Figs 47.1 and 47.2, See Figs 12.8, 12.9, 12.10):
      • Venous Drainage of the Flap (See Figs 12.22, 12.23)
      • Primary:
      • Secondary:
      • Flap Innervation (see Figs 12.19 and 12.22)
      • Sensory
      • Flap Components
      • Advantages
      • Disadvantages
      • Preoperative Preparation
      • Flap Design
      • Anatomic Landmarks
      • General Considerations
      • Special Considerations
      • Design Differences in Free Versus Pedicled Flaps
      • Flap Dimensions
      • Skin Island Dimensions
      • Bone Dimensions
      • Flap Markings
      • Patient Positioning
      • Anesthetic Considerations
      • Technique of Flap Harvest (Subfascial) (Figs 47.6 and 47.7)
      • Flap Modification/Flap Handling
      • Reverse Forearm Flap
      • Suprafascial Flap (Fig. 47.6)
      • Tendinocutaneous Flap
      • Osteocutaneous Flap
      • Tissue Expansion of the Flap
      • Sensate Flap
      • Split Flap
      • Fascial and Adipofascial Flaps
      • Perforator-Based Flaps
      • Flow-Through Flap
      • Donor Site Management
      • Flap Application
      • Pedicled Flaps
      • Free Flaps
      • Indications
      • Postoperative Care
      • Outcomes
      • Expected Outcomes
      • Unfavorable Outcomes
      • Recipient Site
      • Donor Site
      • Conclusion
      • References
      • Further Reading
      • G Local and Free Flaps in The Lower Extremity
      • 48 Local Flaps in the Foot
      • Introduction
      • Vascular Anatomy (Fig. 48.1 and Figs 13.7, 13.9, 13.10, 13.11, 13.15, 13.16 and 13.19)
      • The Sural Flap
      • Flap Anatomy (Figs 48.1 and 13.9 and 13.19)
      • Arterial and Venous Supply of the Flap
      • Dominant:
      • Minor:
      • Minor:
      • Minor:
      • Venous Drainage of the Flap (Fig. 13.19)
      • Primary:
      • Secondary:
      • Flap Innervation (Fig. 13.19)
      • Sensory:
      • Flap Components
      • Advantages
      • Disadvantages
      • Preoperative Preparation
      • Flap Design
      • Anatomic Landmarks
      • General Thoughts About Flap Design
      • Special Considerations
      • Difference in Design, if Any, When Performing the Flap as Pedicled or Free
      • Flap Dimensions
      • Skin Island Dimensions
      • Flap Markings
      • Patient Positioning
      • Anesthetic Considerations
      • Technique of Flap Harvest
      • Flap Modification/Flap Handling
      • Special Instruments
      • Donor Site Closure and Management
      • Technical Tips to Optimize Outcomes and Avoid Complications
      • Flap Usage
      • Pedicled
      • Typical Indications for the Use of This Flap
      • Atypical Indications for the Use of This Flap
      • Postoperative Care and Expected Outcomes
      • General
      • Recipient Site
      • Donor Site
      • Outcomes
      • Expected Outcomes
      • Untoward Outcomes
      • Abductor Digiti Minimi (ADM) Flap
      • Flap Anatomy (Figs 13.11, 13.16 and 13.19)
      • Arterial and Venous Supply of the Flap
      • Dominant:
      • Minor:
      • Venous Drainage of the Flap
      • Primary:
      • Secondary:
      • Flap Innervation (see Figs 13.11 and 13.19)
      • Sensory:
      • Motor:
      • Flap Components
      • Advantages
      • Disadvantages
      • Preoperative Preparation
      • Flap Design
      • Anatomic Landmarks
      • General Thoughts About Flap Design
      • Special Considerations
      • Difference in Design, if Any, When Performing the Flap as Pedicled or Free
      • Flap Dimensions
      • Muscle Dimensions
      • Flap Markings
      • Patient Positioning
      • Anesthetic Considerations
      • Technique of Flap Harvest
      • Flap Modification/Flap Handling
      • Special Instruments
      • Donor Site Closure and Management
      • Technical Tips to Optimize Outcomes and Avoid Complications
      • Flap Usage
      • Pedicled
      • Typical Indications for the Use of This Flap.
      • Atypical Indications for the Use of This Flap.
      • Postoperative Care and Expected Outcomes
      • General
      • Recipient Site
      • Donor Site
      • Outcomes
      • Expected Outcomes
      • Untoward Outcomes
      • Abductor Hallucis (AH) Flap
      • Flap Anatomy (see Fig. 48.6 and Figs 13.11 and 13.19)
      • Arterial and Venous Supply of the Flap
      • Dominant:
      • Minor:
      • Venous Drainage of the Flap
      • Primary:
      • Secondary:
      • Flap Innervation (see Figs 13.11 and 13.19)
      • Sensory:
      • Motor:
      • Flap Components
      • Advantages
      • Disadvantages
      • Preoperative Preparation
      • Flap Design
      • Anatomic Landmarks
      • General Thoughts About Flap Design
      • Special Considerations
      • Difference in Design, if Any, When Performing the Flap as Pedicled or Free
      • Flap Dimensions
      • Muscle Dimensions
      • Flap Markings
      • Patient Positioning
      • Anesthetic Considerations
      • Technique of Flap Harvest
      • Flap Modification/Flap Handling
      • Special Instruments
      • Donor Site Closure and Management
      • Technical Tips to Optimize Outcomes and Avoid Complications
      • Flap Usage
      • Pedicled
      • Typical Indications for the Use of This Flap
      • Atypical Indications for the Use of This Flap.
      • Postoperative Care and Expected Outcomes
      • General
      • Recipient Site
      • Donor Site
      • Outcomes
      • Expected Outcomes
      • Untoward Outcomes
      • Flexor Digitorum Brevis (FDB) Flap
      • Flap Anatomy (see Figs 13.11 and 13.19)
      • Arterial and Venous Supply of the Flap
      • Dominant:
      • Dominant:
      • Minor:
      • Minor:
      • Venous Drainage of the Flap
      • Primary:
      • Secondary:
      • Flap Innervation (see Figs 13.11 and 13.19)
      • Sensory:
      • Motor:
      • Flap Components
      • Advantages
      • Disadvantages
      • Preoperative Preparation
      • Flap Design
      • Anatomic Landmarks
      • General Thoughts About Flap Design
      • Special Considerations
      • Difference in Design, if Any, When Performing the Flap as Pedicled or Free
      • Flap Dimensions
      • Muscle Dimensions
      • Skin Dimensions
      • Flap Markings
      • Patient Positioning
      • Anesthetic Considerations
      • Technique of Flap Harvest
      • Flap Modification/Flap Handling
      • Special Instruments
      • Donor Site Closure and Management
      • Technical Tips to Optimize Outcomes and Avoid Complications
      • Flap Usage
      • Pedicled
      • Typical Indications for the Use of This Flap.
      • Atypical Indications for the Use of This Flap.
      • Postoperative Care and Expected Outcomes
      • General
      • Recipient Site
      • Donor Site
      • Outcomes
      • Expected Outcomes
      • Untoward Outcomes
      • Extensor Digitorum Brevis (EDB) Flap
      • Flap Anatomy (see Fig. 48.11 and Figs 13.15 and 13.19)
      • Arterial and Venous Supply of the Flap
      • Dominant:
      • Minor:
      • Venous Drainage of the Flap
      • Primary:
      • Secondary:
      • Flap Innervation
      • Sensory:
      • Motor:
      • Flap Components
      • Advantages
      • Disadvantages
      • Preoperative Preparation
      • Flap Design
      • Anatomic Landmarks
      • General Thoughts About Flap Design
      • Special Considerations
      • Difference in Design, if Any, When Performing the Flap as Pedicled or Free
      • Flap Dimensions
      • Muscle Dimensions
      • Flap Markings
      • Patient Positioning
      • Anesthetic Considerations
      • Technique of Flap Harvest
      • Flap Modification/Flap Handling
      • Special Instruments
      • Donor Site Closure and Management
      • Technical Tips to Optimize Outcomes and Avoid Complications
      • Flap Usage
      • Pedicled
      • Typical Indications for the Use of This Flap.
      • Atypical Indications for the Use of This Flap.
      • Free Flap
      • Postoperative Care and Expected Outcomes
      • General
      • Recipient Site
      • Donor Site
      • Outcomes
      • Expected Outcomes
      • Untoward Outcomes
      • Lateral Supramalleolar Flap
      • Flap Anatomy (see Figs 13.7, 13.8, 13.16 and 13.19)
      • Arterial and Venous Supply of the Flap
      • Dominant:
      • Venous Drainage of the Flap
      • Primary:
      • Flap Innervation (see Figs 13.7 and 13.8)
      • Sensory:
      • Flap Components
      • Advantages
      • Disadvantages
      • Preoperative Preparation
      • Flap Design
      • Anatomic Landmarks
      • General Thoughts About Flap Design
      • Special Considerations
      • Difference in Design, if Any, When Performing the Flap as Pedicled or Free
      • Flap Dimensions
      • Skin Island Dimensions
      • Flap Markings
      • Patient Positioning
      • Anesthetic Considerations
      • Technique of Flap Harvest
      • Flap Modification/Flap Handling
      • Special Instruments
      • Donor Site Closure and Management
      • Technical Tips to Optimize Outcomes and Avoid Complications
      • Flap Usage
      • Typical Indications for the Use of This Flap
      • Atypical Indications for the Use of This Flap
      • Postoperative Care and Expected Outcomes
      • General
      • Recipient Site
      • Donor Site
      • Outcomes
      • Expected Outcomes
      • Untoward Outcomes
      • Overview of Postoperative Care
      • Conclusion
      • References
      • Further Reading
      • 49 Gracilis Flap
      • Introduction
      • Flap Anatomy (see Fig. 49.1 and Figs 13.1, 13.2, 13.19)
      • Arterial Anatomy (see Figs 49.1, 13.1, 13.2)
      • Dominant Pedicle
      • Dominant:
      • Minor Pedicles
      • Perforator Vessels
      • Venous Anatomy
      • Primary:
      • Nerve Supply (see Fig. 49.1 and Figs 13.1, 13.2 and 13.19)
      • Motor:
      • Sensory:
      • Flap Components
      • Advantages
      • Disadvantages
      • Preoperative Preparation
      • Flap Design and Markings
      • Flap Dimensions
      • Muscle Dimensions
      • Skin Island Dimensions
      • Anesthetic Considerations
      • Technique of Flap Harvest
      • Muscle-Only Flap
      • Segmental Functional Gracilis Flap for Facial Reanimation
      • The Gracilis Skin Paddle Variations and the TUG Flap
      • Gracilis Perforator Flaps
      • Special Instruments
      • Donor Site Closure and Management
      • Technical Tips to Optimize Outcomes and Avoid Complications
      • Flap Usage
      • Indications
      • Postoperative Care
      • Outcomes
      • Conclusion
      • References
      • 50 Gastrocnemius Flap
      • Introduction
      • Flap Anatomy (Figure 50.1 and see Ch. 13 and Figs 13.3, 13.6, 13.9, 13.10, 13.11, 13.19)
      • Arterial Supply of the Flap (Figs 50.1 and 13.3, 13.6, 13.9)
      • Medial Gastrocnemius Muscle
      • Dominant:
      • Minor:
      • Minor:
      • Lateral Gastrocnemius Muscle
      • Dominant:
      • Minor:
      • Venous Drainage of the Flap
      • Primary:
      • Secondary:
      • Flap Innervation (see Fig. 50.1 and Figs 13.9, 13.10, 13.11, 13.19)
      • Motor:
      • Sensory:
      • Sensory:
      • Flap Components
      • Advantages
      • Disadvantages
      • Flap Design and Flap Markings
      • Anatomic Landmarks (Fig. 50.2)
      • General Thoughts About Flap Design
      • Special Considerations
      • Differences in Design, if Any, When Performing the Flap as Pedicled or Free
      • Flap Dimensions
      • Muscle Dimensions
      • Medial Head
      • Lateral Head
      • Skin Island Dimensions
      • Patient Positioning
      • Preoperative Preparation
      • Anesthetic Considerations
      • Technique of Flap Harvest
      • Proximally Based Pedicled Medial Gastrocnemius Muscle Flap (Figs 50.3, 50.4)
      • Proximally Based Pedicled Lateral Gastrocnemius Muscle Flap (Fig. 50.5)
      • Proximally Based Pedicled Medial or Lateral Gastrocnemius Musculocutaneous Flap
      • Flap Modification/Flap Handling
      • Medial Sural Artery Perforator Flap (Video 50.1)
      • Lateral Sural Artery Perforator Flap
      • Distally Based Flap
      • Extension of the Effective Flap Length
      • Chimeric Flap
      • Free or Pedicled Functional Muscle Transfer
      • Technical Tips to Optimize Outcomes and Avoid Complications
      • Use of the Flap
      • Medial Head
      • Typical Indications
      • Atypical Indications
      • Lateral Head
      • Typical Indications
      • Atypical Indications
      • Postoperative Care
      • Outcomes
      • Expected Outcomes
      • Untoward Outcomes
      • Long-Term Outcomes
      • Conclusion
      • References
      • Further Reading
      • 51 Soleus Flap
      • Introduction
      • Flap Anatomy (see Figs 50.1, 2, 4 and Figs 13.3, 13.6, 13.9, 13.10, 13.11, 13.19)
      • Arterial Supply of the Flap (Figs 51.2-51.4 and Figs 13.3, 13.6, 13.9)
      • The Lateral Soleus
      • Dominant:
      • Dominant:
      • Dominant:
      • Minor:
      • The Medial Soleus
      • Dominant:
      • Dominant:
      • Dominant:
      • Minor:
      • Minor:
      • Venous Drainage of the Flap
      • Primary:
      • Flap Innervation (Figs 51.1, 51.5 and 51.6 and see Figs 13.9, 13.10, 13.11, 13.19)
      • Lateral Soleus Muscle
      • Motor:
      • Medial Soleus Muscle
      • Motor:
      • Sensory:
      • Flap Components
      • Advantages
      • Disadvantages
      • Preoperative Preparation
      • Flap Design
      • Anatomic Landmarks (Fig. 51.7)
      • General Thoughts About Flap Design
      • Special Considerations
      • Flap Dimensions
      • Soleus Muscle
      • Skin Island Dimensions
      • Flap Markings (Figs 51.8A, 51.10A)
      • Patient Positioning
      • Anesthetic Considerations
      • Technique of Flap Harvest
      • Medial Approach (Fig. 51.8)
      • Proximally-Based Soleus Muscle Flap (Medial and Lateral as One Unit)
      • Proximally-Based Medial Soleus Muscle
      • Distally-Based Medial Soleus Muscle Flap (Fig. 51.9)
      • Lateral Approach
      • Posterolateral Approach
      • Flap Modifications/Flap Handling
      • Expansion of the Width of the Flap
      • Extension of the Length of the Flap
      • Free Soleus Muscle Flap
      • Donor Site Closure and Management
      • Technical Tips to Optimize Outcomes and Avoid Complications
      • Flap Usage
      • Free Flaps
      • Head and Neck
      • Trunk
      • Upper Extremity
      • Lower Extremity
      • Typical Indications for the Use of This Flap
      • Atypical Indications for the Use of This Flap
      • Postoperative Care
      • General
      • Recipient Site and Donor Site
      • Donor Site
      • Outcomes
      • Expected Outcomes
      • Untoward Outcomes
      • Donor Site
      • Long-Term Outcomes
      • Donor Site
      • Conclusion
      • References
      • Further Reading
      • 52 Fibula Flap
      • Introduction
      • Flap Anatomy (see Fig. 52.1 and Figs 13.6, 13.7, 13.8 and 13.19)
      • Arterial Supply of the Flap (see Fig. 52.1 and Figs 13.6 and 13.7)
      • Dominant:
      • Minor:
      • Diameter:
      • Venous Drainage of the Flap (see Fig. 13.19)
      • Primary:
      • Secondary:
      • Flap Innervation
      • Sensory:
      • Motor:
      • Flap Components
      • Advantages
      • Disadvantages
      • Preoperative Preparation
      • Flap Design (Figs 52.2, 52.3)
      • Anatomic Landmarks
      • General Thoughts About Flap Design
      • Special Considerations
      • Difference in Design, if Any, When Performing the Flap as Pedicled or Free
      • Flap Dimensions
      • Skin Island Length
      • Skin Island Width
      • Bone Length
      • Flap Markings
      • Patient Positioning
      • Anesthetic Considerations
      • Technique of Flap Harvest (Fig. 52.3)
      • Osseus Flap
      • Osteomuscular Flap
      • Osteocutaneous Flap
      • Flap Modification/Flap Handling
      • Donor Site Closure and Management
      • Technical Tips to Optimize Outcomes and Avoid Complications
      • Flap Usage
      • Use of the Flap
      • Typical Indications for the Use of This Flap
      • Atypical Indications for the Use of This Flap
      • Postoperative Care
      • Donor Site
      • Recipient Site
      • Outcomes
      • Expected Outcomes
      • Donor Site
      • Recipient Site
      • Untoward Outcomes
      • Donor Site
      • Recipient Site
      • Long-Term Outcomes
      • Conclusions
      • References
      • 53 Glabrous Skin Flaps
      • Introduction
      • Regional Anatomy (see Figs 13.7, 13.8, 13.11, 13.15, 13.16, 13.17 and 13.19)
      • Arterial Anatomy of the Region (see Figs 13.15 and 13.17)
      • Venous Anatomy of the Region (Figs 53.1 and 13.19)
      • Nerves in the Region (see Figs 13.7, 13.8, 13.11, 13.15, 13.16 and 13.19)
      • Great Toe Pulp Flap and Second Toe Pulp Flap
      • Flap Anatomy
      • Arterial Supply of the Flap (Case 1, Fig. 53.4, see Figs 13.15 and 13.19)
      • Dominant:
      • Minor:
      • Venous Drainage of the Flap (Fig. 53.1)
      • Primary:
      • Secondary:
      • Flap Innervation (Fig. 53.1 and Figs 13.8, 13.15 and 13.19)
      • Sensory:
      • Flap Components
      • Advantages
      • Disadvantages
      • Preoperative Preparation
      • Flap Design
      • Anatomic Landmarks (Fig. 53.2 and Cases 53.1, 53.2 and 53.3)
      • Flap Markings and General Thoughts About Flap Design (Figs 53.4-53.6)
      • Special Considerations
      • Flap Dimensions
      • Skin Island Dimensions
      • Patient Positioning
      • Anesthetic Considerations
      • Technique of Flap Harvest (see Cases 53.1 and 53.3)
      • Special Instruments
      • Flap Modifications
      • Donor Site Closure and Management
      • Technical Tips to Optimize Outcomes and Avoid Complications
      • Flap Usage
      • Pedicled
      • Free Flap
      • Typical Indications for the Use of This Flap
      • Toe Pulp for Volar Thumb Reconstruction
      • Technique
      • Medial Plantar Flap
      • Flap Anatomy (Figs 53.1, 53.7, 13.11, 13.15, 13.16, 13.17, 13.19)
      • Arterial Supply of the Flap (Figs 13.11, 13.15, 13.16, 13.17 and 13.19)
      • Dominant:
      • Venous Drainage of the Flap (see Figs 53.1 and 13.19)
      • Primary:
      • Secondary:
      • Flap Innervation (Fig. 53.1, see Figs 13.11, 13.15, 13.16 and 13.19)
      • Sensory:
      • Motor:
      • Flap Components
      • Advantages
      • Disadvantages
      • Preoperative Preparation
      • Flap Design
      • Anatomic Landmarks (Figs 52.2, 52.3, 53.7C and D)
      • General Thoughts About Flap Design
      • Special Considerations
      • Difference in Design, If Any, When Performing the Flap as Pedicled or Free
      • Flap Dimensions
      • Skin Island Dimensions
      • Flap Markings (Fig. 53.3 and 53.7C)
      • Patient Positioning
      • Anesthetic Considerations
      • Technique of Flap Harvest (see also Case 53.4)
      • Flap Usage
      • Pedicled
      • Free Flap
      • Typical Indications for the Use of This Flap
      • Medial Plantar Free Flap for Reconstruction of a Hand Defect
      • Postoperative Care
      • General
      • Donor Site
      • Outcomes
      • Expected Outcomes
      • General
      • Donor Site
      • Untoward Outcomes
      • General
      • Thumb Pulp Reconstruction with Toe Pulp Flaps
      • Donor Site
      • Long-Term Outcomes
      • Conclusions
      • Further Reading
      • 54 Toe Flaps and Toe Transplantation
      • Introduction
      • Flap Anatomy (see Figure 54.1, Figs 13.7, 13.8, 13.11, 13.15, 13.17, 13.19)
      • Arterial Supply of the Flap (see Figure 54.1, Figs 13.7, 13.15, 13.17)
      • Great Toe, Second Toe, and Combined Second and Third Toe Flaps
      • Dominant:
      • Minor:
      • Isolated Third Toe, Combined Third and Fourth Toe Flaps
      • Dominant:
      • Minor:
      • Venous Drainage of the Flap (see Fig. 13.19)
      • Primary:
      • Secondary:
      • Flap Innervation (see Figure 54.1, Figs 13.8, 13.11, 13.15, 13.19)
      • Sensory:
      • Flap Components
      • Preoperative Preparation
      • Age
      • Vascular Pattern
      • Recipient Site
      • Donor Site
      • Anesthetic Considerations
      • Patient Positioning
      • Great Toe Transfer
      • Indications
      • Advantages
      • Disadvantages
      • Flap Design
      • Anatomic Landmarks (Fig. 54.5)
      • General Thoughts About Flap Design
      • Special Considerations
      • Difference in Design, If Any, When Performing the Flap as Pedicled or Free
      • Flap Dimensions
      • Flap Markings (Fig. 54.5A,B)
      • Technique of Flap Harvest
      • Dorsal Dissection
      • Plantar Dissection
      • Trimmed Great Toe Transfer (Fig. 54.8)
      • Indications
      • Advantages
      • Disadvantages
      • Flap Design (Fig. 54.8)
      • Anatomic Landmarks
      • General Thoughts About Flap Design
      • Special Considerations
      • Flap Dimensions
      • Flap Markings (Fig. 54.8)
      • Technique of Flap Harvest (Fig. 54.8)
      • Wrap-Around Technique (Fig. 54.9)
      • Indications
      • Advantages
      • Disadvantages
      • Technique of Flap Harvest (Fig. 54.9)
      • Twisted-Toe Technique (Fig. 54.10)
      • Second Toe Transfer (Fig. 54.11)
      • Indications
      • Advantages
      • Disadvantages
      • Flap Design (Fig. 54.12)
      • Anatomic Landmarks (Fig. 54.12)
      • General Thoughts About Flap Design
      • Special Considerations
      • Difference in Design, If Any, When Performing the Flap as Pedicled or Free
      • Flap Dimensions
      • Flap Markings (Fig. 54.12)
      • Technique of Flap Harvest
      • Improving the Cosmesis of the Second Toe
      • Second Toe Wrap-Around
      • Indications
      • Technique of Flap Harvest
      • Third Toe Transfer
      • Indications
      • Technique of Flap Harvest
      • Combined Toe Transfers (Fig. 54.15)
      • Second and Third Toe Transfer (Figs 54.15, 54.20)
      • INdications
      • Third and Fourth Toe Transfer
      • Indications
      • Flap Design (Fig. 54.20)
      • Anatomic Landmarks
      • General Thoughts About Flap Design
      • Special Considerations
      • Difference in Design, If Any, When Performing the Flap as Pedicled or Free
      • Flap Dimensions
      • Flap Markings
      • Technique of Flap Harvest
      • Vascularized Joint Transfer
      • Indications
      • Advantages
      • Disadvantages
      • Technique of Flap Harvest
      • PIP Joint Transfer
      • MTP Joint Transfer
      • Neurosensory Free Flaps (See also Chapter 53 - Glabrous skin flaps)
      • Technical Tips to Optimize Outcomes and Avoid Complications
      • General Considerations at the Recipient Site
      • Multiple-Digit Amputation
      • Radial Component Reconstruction: The Thumb
      • Ulnar Component Reconstruction
      • Opposition Reconstruction
      • Single-Digit Amputation
      • Metacarpal Hand
      • Flap Usage
      • Typical Indications for Use of This Flap
      • Atypical Indications for Use of This Flap
      • Recipient Site Preparation and Flap Inset
      • Secondary Procedures to Optimize Outcomes
      • Postoperative Care
      • Motor and Sensory Rehabilitation
      • Outcomes
      • Expected Outcomes
      • Untoward Outcomes
      • Donor Site
      • Recipient Site
      • Long-Term Outcomes
      • Conclusions
      • Further Reading
      • 55 Medial Femoral Condyle and Descending Genicular Artery Perforator Flaps
      • Introduction
      • Flap Anatomy (Figs 55.1, 55.2, see Figs 13.1, 13.2, 13.4 and 13.19)
      • Arterial Anatomy of the Flap (Figs 55.1 and 55.2, see Figs 13.2 and 13.4)
      • Dominant:
      • Secondary:
      • Muscular Branch of the DGA
      • Articular Branch of the DGA
      • Saphenous Branch of the DGA
      • Arterial Supply of Periosteum
      • Upper Transverse Artery (UTA)
      • Branches of the UTA
      • Middle Descending Branch
      • Anterior Descending Branch
      • Central Longitudinal Artery (CLA)
      • Branches of the Cla
      • Anterior Branch
      • Posterior Branch
      • Angiosome of the Skin Paddle
      • Descending Geniculate Artery Distal Cutaneous Branch
      • Saphenous Branch
      • Venous Drainage of the Flap (see Fig. 13.19)
      • Primary:
      • Secondary:
      • Flap Innervation (see Figs 55.1, 13.1, 13.19)
      • Medial Femoral Cutaneous Nerve
      • Saphenous Nerve
      • Sensory:
      • Motor:
      • Flap Components
      • Advantages
      • Disadvantages
      • Preoperative Preparation
      • Flap Design (Fig. 55.3)
      • Anatomic Landmarks
      • General Thoughts About Flap Design
      • Special Considerations
      • Difference in Design, If Any, When Performing the Flap as Pedicled or Free
      • Flap Dimensions
      • Skin Island Dimensions
      • Bone Dimensions
      • Flap Markings (Fig. 55.3A, 55.7B)
      • Patient Positioning
      • Anesthetic Considerations
      • Technique of Flap Harvest
      • Surgical Technique (Fig. 55.3)
      • Flap Modification/Flap Handling
      • Chimeric Flap with Skin, Bone, and Muscle
      • Cutaneous Tendon Graft
      • Special Instruments
      • Donor Site Closure and Management
      • Technical Tips to Optimize Outcomes and Avoid Complications
      • Postoperative Care
      • Flap Usage and Outcomes
      • Free Flap
      • Typical Indications for the Use of This Flap
      • Upper Extremity
      • Lower Extremity
      • Head and Neck
      • Atypical Indications for the Use of This Flap
      • Untoward Outcomes
      • Conclusions
      • References
      • 5 Perforator-Based Workhorse Flaps
      • 56 Perforator Flaps in the Lateral Thoracic Region
      • Introduction
      • Flap Anatomy (Figs 56.1, 56.2 and 11.1, 11.2, 11.3, 11.5, 11.8, and 11.9)
      • Arterial Supply of the Flap (see Figs 56.1, 56.2 and 11.1, 11.2, 11.3, 11.5)
      • Latissimus Dorsi Perforator Flap
      • Dominant:
      • Minor:
      • Thoracodorsal Perforator Flap (Fig. 56.3C)
      • Dominant:
      • Minor:
      • Lateral Thoracic Perforator Flap (Fig. 56.3D)
      • Dominant:
      • Minor:
      • Venous Drainage of the Flap (see Fig. 11.8)
      • Primary:
      • Secondary:
      • Flap Innervation (see Figs 11.2, 11.9)
      • Sensory:
      • Motor:
      • Flap Components
      • Advantages
      • Disadvantages
      • Preoperative Preparation
      • Flap Design
      • Anatomic Landmarks (Fig. 56.5)
      • General Thoughts About Flap Design
      • Special Considerations
      • Differences in Design, If Any, When Performing the Flap as Pedicled or Free
      • Flap Dimensions
      • Skin Island Dimensions
      • Muscle Dimensions
      • Bone Dimensions
      • Flap Markings
      • Patient Positioning
      • Anesthetic Considerations
      • Technique of Flap Harvest
      • Flap Modification/Flap Handling
      • Thinned Flaps
      • Perforator-Based Flap
      • Flow-Through Flap
      • Sensate Flap
      • Composite or Chimeric Pattern Flap Including Muscle and/or Bone
      • Various Composition Flap or Split Cutaneous Flap
      • Tubed Flap
      • Muscle-Sparing Pattern
      • Extended Arc of Rotation Pedicled Flap
      • Special Instruments
      • Donor Site Closure and Management
      • Technical Tips to Optimize Outcomes and Avoid Complication
      • Flap Usage
      • Pedicled
      • Free Flap
      • Head and Neck
      • Trunk
      • Upper Extremity
      • Lower Extremity
      • Typical Indications for the Use of This Flap
      • Skin Resurfacing
      • Sensate Flap
      • Head and Neck Reconstruction
      • Composite or Chimeric Pattern
      • Perforator-Based Flap
      • Dermoadiposal Pattern
      • Atypical Indications for the Use of This Flap
      • Postoperative Care
      • General
      • Recipient Site
      • Donor Site
      • Outcomes
      • Expected Outcomes
      • General
      • For Different Indications
      • Donor Site
      • Untoward Outcomes
      • General
      • Donor Site
      • Long-Term Outcomes
      • Conclusion
      • References
      • Further Reading
      • 57 Deep and Superficial Inferior Epigastric Artery Perforator Flaps
      • Introduction
      • Flap Anatomy (Figure 57.1
      • see Figs 11.2, 11.3, 11.6, 11.8, 11.9, 11.10)
      • Arterial Supply of the Flap (Figures 57.1
      • see 11.2, 11.3 and 11.6)
      • Dominant:
      • Dominant:
      • Minor:
      • Venous Drainage of the Flap (see Figs 11.6 and 11.8)
      • Primary:
      • Primary:
      • Secondary:
      • Flap Innervation (see Figs 11.2, 11.9 and 11.10)
      • Sensory:
      • Motor:
      • Flap Components
      • Advantages
      • Disadvantages
      • Preoperative Preparation
      • Flap Design
      • Anatomic Landmarks
      • General Thoughts About Flap Design
      • Special Considerations
      • Differences in Design, if Any, When Performing the Flap as Pedicled or Free
      • Flap Dimensions
      • Skin Island Dimensions
      • Flap Markings (Figs 57.6 and 57.7)
      • Patient Positioning
      • Anesthetic Considerations
      • Technique of Flap Harvest (Figs 57.8-57.12)
      • Flap Modification/Flap Handling
      • Siamese Flap: Double Pedicle Lower Abdominal Flap
      • Sensate DIEAP Flap
      • Thin Paraumbilical Perforator-Based Flap
      • DIEAP Flap with Vascularized Bone
      • Donor Site Closure and Management
      • Technical Tips to Optimize Outcomes and Avoid Complications
      • Flap Usage
      • Pedicled
      • Free Flap
      • Typical Indications for the Use of This Flap
      • Atypical Indications for the Use of This Flap
      • Postoperative Care
      • General
      • Recipient Site
      • Donor Site
      • Outcomes
      • Expected Outcomes
      • Untoward Outcomes
      • General
      • Breast Reconstruction
      • Regional Reconstruction with Pedicled Flaps
      • Donor Site
      • Long-Term Outcomes
      • Breast Reconstruction
      • Conclusion
      • References
      • Further Reading
      • 58 Superior and Inferior Gluteal Artery Perforator Flaps
      • Introduction
      • Flap Anatomy (Figs 58.1, 58.2 and Figs 13.3 and 13.19)
      • Arterial and Venous Supply of the Flap (Fig. 58.2, see Fig. 13.3)
      • SGAP
      • Dominant:
      • IGAP
      • Dominant:
      • Minor:
      • Venous Drainage of the Flap (see Fig. 13.19)
      • SGAP
      • Primary:
      • Secondary:
      • IGAP
      • Primary:
      • Secondary:
      • Flap Innervation (Fig. 58.1 and Figs 13.3 and 13.19)
      • Sensory:
      • Motor:
      • Flap Components
      • Advantages
      • Disadvantages
      • Preoperative Preparation
      • Flap Design
      • Anatomic Landmarks (Fig. 58.3)
      • General Thoughts About Flap Design
      • SGAP (Fig. 58.4A,B)
      • IGAP (Fig. 58.4C,D)
      • Special Considerations
      • Flap Dimensions
      • SGAP Dimensions
      • IGAP Dimensions
      • Flap Markings (Figs 58.4-58.6)
      • Patient Positioning
      • Anesthetic Considerations
      • Technique of Flap Harvest (Figs 58.7, 58.8)
      • Flap Modification/Flap Handling
      • Donor Site Closure and Management
      • Technical Tips to Optimize Outcomes and Avoid Complications
      • Flap Usage
      • Typical Indications for the Use of This Flap
      • Postoperative Care
      • Outcomes
      • Expected Outcomes
      • Untoward Outcomes (Table 58.2)
      • Long-Term Outcomes
      • Conclusions
      • References
      • Further Reading
      • 59 Anterolateral and Anteromedial Thigh Flaps
      • Introduction
      • Anterolateral Thigh Flap
      • Flap Anatomy (see Figs 59.1, 13.1, 13.2, 13.4, 13.19)
      • Arterial Supply of the Flap (Figs 59.1, 13.1, 13.2 and 13.4)
      • Dominant:
      • Minor:
      • Venous Drainage of the Flap
      • Primary:
      • Flap Innervation (Figs 13.2 and 13.19)
      • Sensory:
      • Motor:
      • Flap Components
      • Advantages
      • Disadvantages
      • Preoperative Preparation
      • Flap Design
      • Anatomic Landmarks (Fig. 59.2)
      • General Thoughts About Flap Design
      • Special Considerations
      • Head and Neck Reconstruction
      • Abdominal Wall Reconstruction
      • Upper Extremity Reconstruction
      • Lower Extremity Reconstruction
      • Breast Reconstruction
      • Differences in Design, if Any, When Performing the Flap as Pedicled or Free
      • Flap Dimensions
      • Skin Island Dimensions
      • Muscle Dimensions
      • Flap Markings
      • Patient Positioning
      • Anesthetic Considerations
      • Technique of Flap Harvest (Figs 59.4-59.8)
      • Suprafascial Dissection (Figs 59.3, 59.4)
      • Subfascial Dissection (Figs 59.5, 59.6, 59.7, 59.8)
      • Flap Modification/Flap Handling
      • Thin Flap
      • When Bulk is Required
      • Adipofascial Flap
      • Innervated Flap (Fig. 13.19)
      • Flow-Through Flap
      • Defects Requiring a Wide Skin Flap
      • Use of Fascial Component
      • Muscle Component Only
      • Pedicled Flap
      • Anteromedial Thigh Flap
      • Arterial Supply of the Flap (Figs 59.1 and 13.1, 13.2, 13.4)
      • Dominant:
      • Minor:
      • Venous Drainage of the Flap
      • Primary:
      • Technique of Flap Harvest
      • Anterolateral and Anteromedial Thigh flaps
      • Donor Site Closure and Management
      • Technical Tips to Optimize Outcomes and Avoid Complications
      • Lack of Adequate Skin Vessels
      • Twisting of the Pedicle
      • The Motor Nerve between the Vessel Branches
      • Excess Fat in Obese Patients
      • Flap Usage
      • Pedicled
      • Free Flap
      • Typical Indications for the Use of This Flap
      • Head and Neck Reconstruction
      • Abdominal Wall Reconstruction
      • Upper Extremity Reconstruction
      • Lower Extremity Reconstruction
      • Atypical Indications for the Use of This Flap
      • Esophageal Reconstruction
      • Breast Reconstruction
      • Perineum and Penile Reconstruction
      • Postoperative Care
      • General
      • Recipient Site
      • Donor Site
      • Outcomes
      • Expected Outcomes
      • General
      • Different Indications
      • Donor Site
      • Untoward Outcomes
      • General
      • Different Indications
      • Donor Site
      • Long-Term Outcomes
      • General
      • Different Indications
      • Donor Site
      • Conclusion
      • Further Reading
      • 60 Tensor Fascia Lata Flap
      • Introduction
      • Flap Anatomy (Fig. 60.1 and Figs 13.1, 13.2 and 13.19 )
      • Arterial Supply of the Flap (see Fig. 60.1 and Figs 13.1, 13.2)
      • Dominant:
      • Minor:
      • Venous Drainage of the Flap
      • Primary:
      • Secondary:
      • Flap Innervation
      • Motor:
      • Flap Components
      • Advantages
      • Disadvantages
      • Preoperative Preparation
      • Flap Design (Figs 60.2, 60.3, 60.4)
      • Anatomic Landmarks
      • General Thoughts about Flap Design
      • Special Considerations
      • Difference in Design, if Any, When Performing the Flap as Pedicled or Free
      • Flap Dimensions
      • Muscle Dimensions
      • Skin Island Dimensions
      • Fascia Dimensions
      • Bone Dimensions
      • Flap Markings (Figs 60.2, 60.3, 60.4, 60.6)
      • Patient Positioning
      • Anesthetic Considerations
      • Technique of Flap Harvest
      • Tensor Fascia Lata Muscle Flap
      • Free Microvascular Transfer of the TFL Muscle Flap
      • Tensor Fascia Lata Musculocutaneous Flap (Fig. 60.8)
      • Tensor Fascia Lata Osteomusculocutaneous Flap
      • Musculo-Osseous Flap
      • Flap Modifications/Flap Handling
      • Transverse Skin Island
      • Osseo-Muscle or Osseo-Musculocutaneous Flap
      • Expanded Skin Island
      • Tissue Expansion
      • Delayed Flap
      • Neurosensorial Flap
      • Functional Muscle
      • Chimeric Flap
      • Perforator Flap
      • Fascia Flap
      • V-Y Advancement Flap
      • Special Instruments
      • Donor Site Closure and Management
      • Technical Tips to Optimize Outcomes and Avoid Complications
      • Flap Usage
      • Typical Indications for the Use of This Flap
      • Pedicled
      • Free Flap
      • Atypical Indications for the Use of This Flap
      • Pedicled
      • Free
      • Postoperative Care
      • General
      • Recipient Site
      • Donor Site
      • Outcomes
      • Expected Outcomes
      • General
      • Donor Site
      • Untoward Outcomes
      • References
      • Further Reading
      • 61 Posterior Tibial Artery Perforator Flap
      • Introduction
      • Flap Anatomy (Fig. 61.1 and see Ch. 13 and Figs 13.6, 13.7, 13.10, 13.11, 13.12, 13.13, 13.19)
      • Arterial Supply of the Flap (Fig. 61.1 and see Figs 13.6 and 13.10)
      • Dominant:
      • Minor:
      • Venous Drainage of the Flap (see Fig. 13.19)
      • Primary:
      • Secondary:
      • Flap Innervation (see Fig. 61.1 and Fig. 13.19)
      • Sensory:
      • Motor:
      • Flap Components
      • Advantages
      • Disadvantages
      • Preoperative Preparation
      • Flap Design
      • Anatomic Landmarks (Figs 61.2, 61.3)
      • General Thoughts About Flap Design
      • Special Considerations
      • Differences in Design, if Any, When Performing the Flap as Pedicled or Free
      • Flap Dimensions
      • Skin Island Dimensions
      • Muscle Dimensions
      • Bone Dimensions
      • Flap Markings
      • Patient Positioning
      • Anesthetic Considerations
      • Technique of Flap Harvest
      • Flap Modification/Flap Handling
      • Flow-Through Flap
      • Chimeric Flap
      • Fascial Flap
      • Extended Flap
      • Donor Site Closure and Management
      • Technical Tips to Optimize Outcomes and Avoid Complications
      • Flap Usage
      • Pedicled
      • Free Flap
      • Typical Indications for the Use of This Flap
      • Atypical Indications for the Use of This Flap
      • Postoperative Care
      • General
      • Recipient Site
      • Donor Site
      • Outcomes
      • Expected Outcomes
      • General
      • Different Indications
      • Donor Site
      • Untoward Outcomes
      • General
      • Donor Site
      • Long-Term Outcomes
      • General
      • Different Indications
      • Donor Site
      • Conclusion
      • References
      • Further Reading
      • 62 Free-style Flaps
      • Introduction
      • Flap Anatomy
      • Flap Components
      • Advantages
      • Disadvantages
      • Flap Design
      • Anatomic Landmarks
      • General Thoughts About Flap Design
      • Special Considerations
      • Technique of Flap Harvest (Cases 62.1-62.4)
      • Flap Modification/Flap Handling
      • When Bulk is Required
      • When Muscle is Needed at the Recipient Site
      • When Fascia is Required for the Reconstruction
      • When Bone is Required
      • When Multiple Skin Islands are Required
      • "Recycling" a Flap
      • Flap Usage
      • Reconstruction of Defects in Any Part of the Body
      • Postoperative Care
      • Outcomes
      • Conclusions
      • References
      • 6 Reconstructive Transplant Surgery
      • 63 Starting a Reconstructive Transplantation Program
      • Introduction
      • Should an Institution Develop a Reconstructive Transplant Program?
      • Forming the Team
      • Research or Clinical Practice
      • Committee Approvals
      • Funding the Program
      • The Organ Procurement Organization
      • Going Live
      • Maintaining an Active Program
      • Conclusions
      • References
      • 64 Face Transplantation
      • Introduction
      • Immune Suppression
      • Acute Rejection
      • Chronic Rejection
      • GVHD
      • Immune Tolerance
      • Side Effects of Immune Suppression
      • Indications
      • Trauma and Burns
      • The Military
      • Congenital Defects
      • Infectious Disease
      • Malignant Disease
      • Future Indications
      • Preoperative Considerations
      • Patient Selection
      • Donor Considerations
      • Surgical Planning
      • Surgical Technique
      • Postoperative Considerations
      • Complications
      • Outcomes
      • Medical Outcomes
      • Functional Outcomes
      • Aesthetic Outcomes
      • Social Outcomes
      • Discussion
      • Future Directions
      • References
      • 65 Hand and Upper Extremity Transplantation
      • Introduction
      • Immunotherapy
      • Indications
      • Preoperative Considerations
      • Patient Screening
      • Preoperative Planning
      • Cadaver Rehearsal
      • Team Assignments
      • Rotating Surgeons
      • Use or Replace Existing Motors
      • Ischemia Time
      • Surgical Technique
      • Donor Operation
      • Anesthesia Considerations
      • Operating Room Set-Up
      • Dissections
      • Osteosynthesis
      • Muscle/Tendon Reconstruction
      • Nerve Reconstruction
      • Revascularization
      • Skin Closure
      • Dressings
      • Transplant Level, Specific Techniques
      • Distal Forearm (see Case 65.1, left hand)
      • Middle Forearm
      • Proximal Forearm (see Case 65.2, left forearm)
      • Transhumeral (see Cases 65.1 and 65.2, right upper limbs)
      • Postoperative Considerations
      • Complications
      • Outcomes
      • Future Directions
      • References
      • 66 Laryngeal, Abdominal Wall, and Uterus Transplantation
      • Introduction
      • Laryngeal Allotransplantation
      • Arterial Anatomy (Fig. 66.1 and Figs 10.4 and 10.5)
      • Venous Anatomy
      • Neural Anatomy
      • Indications
      • Laryngeal Composite Tissue Component (Fig. 66.1)
      • Flap Design
      • Donor Procedure
      • Recipient Procedure
      • Flap Modifications
      • Postoperative Care
      • Immunosuppressive Protocol
      • Future Landmarks
      • Abdominal Wall Allotransplantation
      • Arterial Anatomy (see Fig. 66.2 and Figs 11.3 and 11.6)
      • Venous Anatomy (see Fig. 11.8)
      • Neural Anatomy (see Figs 11.9 and 11.10)
      • Indications
      • Abdominal Wall Composite Tissue Component (Fig. 66.2)
      • Flap Design
      • Donor Procedure
      • Recipient Procedure
      • Flap Modifications
      • Postoperative Care
      • Immunosuppressive Protocol
      • Future Landmarks
      • Uterus Transplantation
      • Arterial Anatomy
      • Venous Anatomy
      • Neural Anatomy
      • Indications
      • Uterine Transplanted Tissue Component (Fig. 66.3A)
      • Flap Design
      • Donor Procedure
      • Surgical Procedure in the Donor
      • Recipient Procedure
      • Surgical Procedure in Recipient
      • Flap Modifications
      • Postoperative Care
      • Immunosuppressive Protocol
      • Future Landmarks
      • Case Report
      • The Donor
      • Surgical Procedure
      • Immunosuppressive Protocol
      • Prophylaxis
      • Results
      • Other CTAs in Case Reports
      • References
      • 67 Immunology and Research in Reconstructive Transplantation
      • Introduction
      • Basics of Transplantation Immunology
      • The Role of the MHC/HLA Antigens
      • Non-HLA Antigens
      • ABO Blood Group Antigens
      • Minor Histocompatibility Antigens
      • Allorecognition Pathways
      • T-Cell Activation
      • B-Cell Activation
      • Rejection
      • Hyperacute Rejection
      • Accelerated Rejection
      • Acute Rejection
      • Chronic Allograft Vasculopathy (Chronic Rejection)
      • Immunologic Factors of Chronic Rejection
      • Non-Immunologic Factors of Chronic Rejection
      • Tolerance
      • Chimerism and Donor Bone Marrow Transplantation
      • Cell-Based Therapies in VCA
      • T-Regulatory Cells
      • Dendritic Cells
      • Mesenchymal Stem Cells
      • References
      • 68 Peripheral Nerve Allotransplantation
      • Introduction
      • Peripheral Nerve Regeneration
      • Nerve Allotransplantation
      • Schwann Cells and Immunology of Nerve Allotransplantation
      • Current Strategies for Nerve Allotransplantation
      • Clinical Experience with Nerve Allotransplantation
      • Nerve Regeneration in Vascularized Composite Allotransplantation
      • Summary
      • Nerve Autograft Substitutes
      • Conduits and Processed Nerve Allografts
      • Nerve Conduits
      • Processed Nerve Allografts
      • Conclusion
      • References
      • Index
      • A
      • B
      • C
      • D
      • E
      • F
      • G
      • H
      • I
      • J
      • K
      • L
      • M
      • N
      • O
      • P
      • R
      • S
      • T
      • U
      • V
      • W
      • Y
      • Z
      • Inside Back Cover

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