soft tissue coverage of the upper limb · 2011-07-04 · soft tissue coverage of the upper limb...
TRANSCRIPT
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SOFT TISSUE COVERAGE
OF THE UPPER LIMB
PEDICLED MUSCLE and
FASCIO-CUTANEOUS FLAPS
AC Masquelet Mars 2007
DIU chirurgie de la Main
Présenté par M. Beustes-Stefanelli
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HISTORIC OF FLAPS
• WOOD (1863)
• TANSINI (1892)
• ESSER (1917)
• LITTLER (1953)
• Mc GREGOR (1972)
• OLIVARI (1976)
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SKIN VASCULARISATION
• MICHEL SALMON
- «!Les Arteres de la
Peau!»! (1936)
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SKIN AND FLAP VASCULARISATION
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ADVANCES 1980-2000
• DISTALLY-BASED
FLAPS (1981)
• ANATOMY
• VENO and NEURO
CUTANEOUS FLAP
• ADIPO-FASCIAL
PEDICLED FLAPS
• COMPOSITE FLAPS
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REPAIR OF THE UPPER LIMB
THE PAST
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SOFT TISSUE COVERAGE
and UPPER LIMB
• FEW INDICATIONS OF FREE FLAPS
• NUMEROUS POSSIBILITIES OF
PEDICLED FLAPS
• JOINTS MOTION and TENDONS
COURSE require SKIN FLAPS and
FASCIO-CUTANEOUS FLAPS
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PEDICLED FLAPS for the UPPER LIMB
• THE «!TREE!» OF
THE FLAPS FOR
THE UPPER LIMB
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SHOULDER GIRDLE
• LATISSIMUS DORSI FLAP
• PECTORALIS FLAPS
• SCAPULAR FLAPS
• POSTERIOR ARM FLAP
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ANATOMY of the SHOULDER GIRDLE
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THE «!KING!» DONOR SITEFOR ISOLATED, ASSOCIATED
AND COMPOUND FLAPS
• BONE
• SKIN
• FASCIA
• MUSCLE
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LATISSIMUS DORSI: THE «!KING!»
VASCULARISATION
TYPE V ACCORDING
THE CLASSIFICATION
OF MATHES AND
NAHAI
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LATISSIMUS DORSI : TECHNIQUE
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LATISSIMUS DORSI
• ARC OF
ROTATION OF
THE MUSCLE
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UPROOTED LEFT UPPER LIMB
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TIKHOFF PROCEDURE
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TIKHOFF PROCEDURE
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COMPOUND DEFECT
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COMPOUND TRANSFER
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SCAPULAR FLAPS : ANATOMY
• POSTERIOR
CIRCONFLEX
ARTERY
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SCAPULAR FLAPS: TECHNIQUE
• INDICATIONS:
- REPAIR OF THE
ARMPIT
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PARASCAPULAR FLAP
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SCAPULAR FLAP
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POSTERIOR ARM FLAP
SKIN ARTERIAL
BRANCH FROM
VASTUS MEDIALIS
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POSTERIOR ARM FLAP
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PECTORALIS MUSCLES FLAPS
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PECTORALIS MINOR
ARC OF
ROTATION
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PECTORALIS MINOR
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PECTORALIS MINOR
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COVERAGE OF THE
ELBOW
• LATERAL ARM FLAP
• BRACHIO-RADIALIS
• POSTERIOR INTEROSSEOUS FLAP
• LATISSIMUS DORSI FLAP
• ANTECUBITAL FLAP
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ANTECUBITAL FLAP
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LATISSIMUS DORSI FLAP
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LATISSIMUS DORSI FLAP
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CHINESE FLAPS
SHANG-TI-SHEN
RUYAO SONG
• 1982
YANG KUO-FAN
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LATERAL ARM FLAP: ANATOMY
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LATERAL ARM FLAP: TECHNIQUE
• INDICATIONS:
- COVERAGE OF
ANTERIOR AND
POSTERIOR
ASPECTS OF THE
ELBOW
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LATERAL ARM FLAP IN EXTENSIVE
ARTHROLYSIS OF THE ELBOW JOINT
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COVERAGE OF HAND AND
WRIST
• RADIAL and ULNAR FLAPS
• POSTERIOR INTEROSSEOUS FLAP
• DISTAL ULNAR FLAP
• ANTERIOR INTEROSSEOUS FLAP
• PRONATUS QUADRATUS FLAP
• GROIN FLAP !
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RADIAL FOREARM FLAP
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RADIAL FO REARM FLAP
• INDICATIONS:
- COVERAGE OF
THE DORSUM OF
HAND AND
FINGERS
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RADIAL FOREARM FLAP
• ARC OF
ROTATION IS
INCREASED BY
DECROSSING THE
TENDONS
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RADIAL FOREARM FLAP
• EXTENDED NECROSIS
BY ANTIMITOTIC
AGENT
• ITERATIVE EXCISION
• COVERAGE BY A
«!!CHINESE!» FLAP
• MP ARTHROLYSIS
• TWO-STAGES
RECONSTRUCTION of
EXTENSOR TENDONS
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RADIAL FOREARM FLAP
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ULNAR FOREARM FLAP
NEW INTEREST !
VERY LONG
PEDICLE !
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RADIAL FOREARM FLAP WITHOUT
RAISING THE RADIAL ARTERY
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POSTERIOR INTEROSSEOUS FLAP
ANATOMY
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POSTERIOR INTEROSSEOUS FLAP
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SEQUELLAE OF BURNS
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SEQUELLAE OF BURNS
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PIO FLAP and 1st WEB
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POSTERIOR INTEROSSEOUS FLAP
• PROXIMALLY-
BASED FLAP
• SMALL DEFECTS
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THE POSTERIEUR INTEROSSEOUS
FLAP FOR COVERING THE ELBOW
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OSTEO-CUTANEOUS DEFECT ON THE
ULNAR SIDE
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DISTAL ULNAR FLAP
• INDICATIONS:
ULNAR and DORSAL
ASPECTS of HAND
and WRIST
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PRONATUS QUADRATUS FLAP
• FEW INDICATIONS
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GROIN FLAP
• COVERAGE OF
ELBOW, FOREARM,
HAND AND WRIST
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PEDICLED GROIN FLAP
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SOFT TISSUE REPAIR OF
THE UPPER LIMB
• CONCLUSIONS:
- LATISSIMUS
DORSI and GROIN
FLAP CAN BE
USED IN THE
MAJORITY OF
THE DEFECTS