Microvascular Reconstruction: Anatomy, Applications and by Ralph T. Manktelow M.D., F.R.C.S.(C) (auth.)

By Ralph T. Manktelow M.D., F.R.C.S.(C) (auth.)

Reconstructive microvascular surgical procedure is now in its young people. at the start many inspiration this newborn used to be a whim and might fail to thrive. a few have been un­ sure, others with imaginative and prescient both supported or grew to become actively taken with this new zone of surgical endeavour. even though preliminary curiosity used to be curious about the replantation of amputated elements, it's been the single degree loose trans­ fer of dwelling tissue to website which has introduced microsurgery into the surgical highlight. From its humble beginnings we've got witnessed a revolution during this department of cosmetic surgery; the various lengthy validated equipment of recon­ struction have, like barricades, fallen prior to the advances made during this box. In its infancy there have been quite few tactics on hand. there has been an inclination to make the patient's challenge healthy the operation, instead of the opposite, and this often ended in an inferior end result. The then recognized flaps, resembling the groin flap and the deltopectoral flap, have been hired. regrettably they have been websites which posed many technical difficulties; specifically these of vascular anomaly, a quick pedicle and vessels of small cal­ ibre. lengthy operations have been the norm, and vascular thrombosis used to be no longer un­ universal. health center regimen usually used to be disrupted and there has been a possibility that those new concepts might fall into disrepute. during the last decade this situation has replaced dramatically.

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Additional info for Microvascular Reconstruction: Anatomy, Applications and Surgical Technique

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S. A) carries the scapular flap. The C. S. A winds posteriorly around the subscapularis, and passes through the muscular triangle created by the teres minor and major and the long head of the triceps. During its course, it gives off muscular branches to the subscapularis, infra-spinatus, and teres musculature. There are two terminal branches: a deep descending branch, running deep to the teres major, along and supplying the lateral border of the scapula, and a cutaneous branch which hugs the teres minor as it passes to the subcutaneous tissues.

The flap may be outlined to include the entire volar forearm skin. However, if a small flap is required, it may be outlined anywhere along the flap axis, as indicated by two of the possibilities illustrated 26 Chapter 4. ~'"'tIIll Superficial branch of radial nerve --IH'H7-'tS1~VI Antebrachial fascia a Extensor carpi radialis longus and brevis Radius Flexor polllcis longus b Fig. 4-2. a The course, relationship and branches of the radial artery. Many small branches pass superficially and deeply in the intermuscular septum to supply both the skin and the radius.

Identify and develop the posterior muscle border and separate the gracilis from the adductor magnus. Dissect a plane between the adductor longus and gracilis. Retract the adductor longus and identify the dominant neurovascular pedicle found 6-12 cm from the pubic tubercle (Fig. 6-8 c). Identify the motor nerve entering the muscle on its deep surface,just proximally to the neurovascular pedicle. It lies on the adductor magnus and is loosely attached to it. Fig. 6-8. a With the hip flexed, abducted and externally rotated, and the knee flexed, a line drawn between the easily palpable adductor longus tendon and the tibial tubercle, marks the anterior border of the gracilis muscle.

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