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Arterial supply to a pec flap
- pectoralis branch of the thoracoacromial artery (from middle third of the axillary artery)
- Secondary supply from lateral thoracic, supreme thoracic. Skin also supplied by internal mammary arteries.
- innervated by medial and lateral pectoral nerves
How do you determine the location of the thoracoacromial artery?
The course of the pectoral branch of the thoracoacromial artery can be identified by drawing a line from the xyphoid to the acromion. A second line perpendicular to this line is drawn that bisects the clavicle. The course of the artery corresponds to the line drawn from the midpoint of the clavicle continuing to the medial portion of the acromion to xyphoid line.
Describe the blood supply to a fibula free flap
Primarily from the peroneal artery, which branches from the popliteal or posterior tibial. The primary blood supply to the harvested fibula flap is derived from periosteal perforators traveling circumferentially around the fibula.
Innervation of fibular free flap
lateral cutaneous branches of sural nerve
Primary blood supply to the scapular free flap
circumflex scapular branch of the subscapular artery
Length of bone available in fibula reconstruction
25 cm (must leave some of the 40 cm long fibula)
In preoperative evaluation of pt or fibula free flap, what must be done to reduce the risk of post-op ischemia in the lower extremity?
Demonstration of 3 vessel flow to allow harvest of peroneal artery
length of radius bone that can be safely harvested without unacceptable forearm dysfunction.
10 to 12 cm. Forearm donor site must be plated after removal of bone to reduce risk of post-op fracture.
The skin paddles of the scapular flap can also be separated into scapular and parascapular skin paddles based on which arteries?
The transverse and descending branches of the circumflex scapular artery, respectively.
Amount of bone that can be harvested from scapular free flap?
For a radial forearm fasciocutanous free flap, these are the vessels and nerves that supply the donor tissue.
- Radial artery
- Venae comitantes or cephalic vein
- Medial and lateral antebrachial cutaneous nerves
What is the blood supply to the skin paddle in a fibula free flap? How is this protected intraoperatively?
- Septocutaneous perforators that traverse the posterior crural septum
- Musculocutaneous perforators that run through the flexor hallucis and soleus may also supply the skin. Consequently, when harvesting an osteocutaneous fibular flap, one should include a cuff of flexor hallucis and soleus muscle to protect these perforators.
For an ALT free flap, these are the vessels and nerves that supply the donor tissue.
- Artery: descending branch, lateral circumflex femoral
- Vein: venae comitantes
- Nerve: lateral femoral cutaneous
For a rectus abdominis free flap, these are the vessels and nerves that supply the donor tissue.
- Artery: deep inferior epigastric artery
- Vein: deep inferior epigastric vein
- Nerve: intercostals (mixed motor/sensory)
What percentage of people have an incomplete superficial palmar arch and poor communication between the deep and superficial arches precluding the harvest of a radial forearm free flap?
This osteocutaneous flap has the highest bone quality for osteointegration.
Iliac crest. Can donate up to 16 cm of bone.
These two substances are applied via micro-irrigation during microvascular anastomoses.
- heparinized lidocaine for irrigating thrombus from open vessel lumens.
- Papaverinefor arterial vaso-spasm
A size mismatch of what degree precludes vessel anastomosis?
Leeches are used for venous congestion because of their production of which two compounds? What antibiotic prophylaxis should be begun when leeches are used?
- Leeches produce both hementin and hirudin, which provide local anesthesia and anticoagulation.
- The leech also harbors a gram-negative organism (Aeromonas hydrophila). Ciprofloxacin or bactrim are commonly used for prophylaxis.