MicroVascular Techniques for Limb Salvage Plastic & - PowerPoint PPT Presentation

4/20/2013 MicroVascular Techniques for Limb Salvage Plastic & Reconstructive MicroSurgery � Angiosomes � Ian Taylor, MD � San Francisco (Harry Charles K Lee, MD, FACS Buncke, MD, Stephen Mathes, MD) Chief of Plastic Surgery & Microsurgery, � Perforator Flaps St.Mary’s Medical Center, San Francisco � Local Fascial Flaps Assistant Clinical Professor of Surgery, � Local Propellar Flaps University of California, San Francisco (UCSF) � Arterial Flow Through Free Flap � Venous Flow Through Free Flap Ian Taylor, MD, Plastic Surgery, Australia, 1987 4/20/2013 4/20/2013 1

4/20/2013 Angiosome Map Lower Extremity Reconstruction with Multiple Perforators throughout Body Local Perforator Fascial Flaps and Skin Septal Graft IntraMuscular � Flap Harvest (Soft Tissue + Artery and Vein) Expanded the Repetoire of Free Tissue Transfer 4/20/2013 2

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4/20/2013 4 weeks postop 4

4/20/2013 Propellar Flaps based on Perforators 5

4/20/2013 ALT Perforator Flap � AnteroLateral Thigh Perforator Flap (Arterial Flow Through Flap) � “ Thin ” and pliable � 1984—Song, et al; Br. Jo. of Plastic Surgery � Patient population differs � Reliable anatomy � Long pedicle (20cm) � Large surface area (40X20cm) � Sensate (Lateral femoral cutaneous nerve) � Chimeric/composite � Easy harvest � Medial Dissection first � Minimal Donor Site � Septocutaneous perforator � Ideal Soft Tissue Flap 6

4/20/2013 � Lateral circumflex femoral � Lateral descending branch � Vastus Lateralis � Rectus Femoris � 80% muscular perforators (Wei 2002) � 20% septocutaneous perforators � Perforator can be wrapped around branches of femoral nerve to Vastus ALT Perforator Flap � Advantages: � Workhorse flap � Consistent Anatomy-septocutaneous, musculocutaneous � Long pedicle (20cm), Large surface area (20X40cm) � Contoured/thinned � Neurotized (sensate) � Composite/Chimeric � Donor Site—Primary Closure (<8cm) � Disadvantages: � Tedious dissection if muscular perforator � Not always thin (female vs. male) � Technical considerations insetting � Pedicle orientation and pressure � Unsitely donor site if not closed primarily 7

4/20/2013 Venous Flow Through Flap Calcaneal Wound, CLI � Cephalic Vein/ Saphenous Vein � Flow through flap Skin Replacement - Flap Skin Replacement - Flap 8

4/20/2013 Skin Replacement - Flap Venous Flow Through Free Flap � Flow through flap Skin Replacement - Flap Skin Replacement - Flap � Flow through flap 9

4/20/2013 Expanding Role of Microsurgery & Vascular Surgery � Angiosome Concept � Thank you! � Perforator LOCAL Flaps � Perforator FREE Flaps � Arterial Flow Through � Venous Flow Through FREE Flaps � --Simultaneous Soft Tissue and Vascular Reconstruction 10