In 1978, saijo was the first to describe the scapular fasciocutaneous flap anatomy based on the circumflex scapular artery csa. Microsurgery medial sural artery perforator msap flap. Original article reconstruction in extensive axillary. The flaps used are often prefabricated or preexpanded 4,8. The deltoid free flap is a neurovascular fasciocutaneous tissue, providing relatively thin sensate tissue for use in softtissue reconstruction. Our pdf merger allows you to quickly combine multiple pdf files into one single pdf document, in just a few clicks. Other problems associated with skin grafting are poor aesthetic appearance, hyperpigmentation and dryness. The scapular parascapular system of flaps is a unique system of flaps available for free tissue transfer based on the subscapular artery and its branches. Inferior glide 2 x 10 push arm straight down for 5 seconds. Select or drag your files, then click the merge button to download your document into one pdf file.
The submental island flap for reconstruction of intramural defects in oral cancer patients. Together, they can provide an excellent reconstructive solution directed at restoration of facial morphology, in terms of natural appearance and longlasting. Planning it eccentrically allows the flap to reach up to the lower third of the arm comfortably. Merger procedure article 61b in conjunction with art 62 date. Free flap reconstruction of the lower back and posterior pelvis. Ateriovenous subclaviashunt for head and neck reconstruction. Typical free flaps are the latissimus dorsi flap, the parascapular flap or perforator flaps such as the deep inferior epigastric perforator diep or the alt flap. Site director, phoenix orthopaedic residency program. Banking parascapular flap for correction of severe.
Wound coverage techniques for the injured extremity. The conjoined parascapular and latissimus dorsi free flap. With pdf merger you can merge your multiple pdf files to a single pdf file in matter of seconds. Its significance to scapular parascapular flaps and potential for free fascial flaps. A free scapular flap was used to reconstruct head and neck defects in 36 patients between june 1986 and au gust 1989.
Complex reconstructions in head and neck cancer surgery. Flap systems or trailing edge assemblies are wing aerostructures, attached to the. The flaps used to cover the defects are shown in table 1. The combined parascapular fasciocutaneous and latissimus. Free parascapular flap for head and neck reconstruction.
The parascapular flap is oriented vertically, from the triangular space to a point midway between the tip of the scapula and the iliac crest. If perforator flaps are used, flaps can be thinned to the subdermal plexus. Scapula free flap for complex maxillofacial reconstruction. The latissimus dorsi myocutaneous flap ldmf is one of the most reliable and versatile flaps used in reconstructive surgery. Fasciocutaneous flap reconstruction of the tongue and.
Nowadays, microvascular free flaps represent the main choice for the reconstruction of these defects. The deltoid fasciocutaneous flap was first described anatomically and applied clinically by franklin. A variant of the parascapular flap is the inframammary extended circumflex scapular imecs flap, in which the axis of the flap is rotated anteriorly, across the lateral chest and into the inframammary fold. Reconstruction of the facial hard and soft tissues is of special concern for the rehabilitation of patients especially after ablative tumor surgery has been performed.
The flap can be larger in width than the scapular flap, approaching 15 cm and has been harvested as long as 25 cm. No prospective randomized controlled studies for comparison of different free flaps are. Cancer may involve composite elements and the in sano resection may lead to an extensive tissue defect. Free parascapular flap transfer combined with colemans lipoinjection, according to the authors results, is the procedure of choice for facial contour restoration. We evaluated the conjoined parascapular and latissimus dorsi free flap as an alternative reconstructive option. The use of fasciocutaneous and osteofasciocutaneous. In conclusion, we describe the reconstruction of the total esophagus using a tubed parascapular free. Scapularperiscapular exercises table slides abduction 2 x 10 slide arm and body together across table. The cutaneous scap ular flap was used in five cases and the osteocutaneous flap in 31 cases. Nerve anatomy thoracodorsal nerve figures 4, 11 runs along the pedicle to the latissimus muscle. Split pdf files into individual pages, delete or rotate pages, easily merge pdf files together or edit and modify pdf files. Aesthetic reconstruction of the severely disfigured burned. Ligating the horizontal branch allows a further mobilization of the pedicle by 23 cms. This combination allows the creation of an extremely large cutaneous flap from the dorsal thorax while ensuring survival of both the muscle and skin.
You can either select the files you want to merge from you computer or drop them on. Wound coverage techniques for the injured extremity gil ortega, md, mph sonoran orthopaedic trauma surgeons. The parascapular flap provides a fasciocutaneous flap with similar characteristics to those of the scapular flap. A free and open source software to merge, split, rotate and extract pages from pdf files. Among the various flaps proposed, the scapula flap has favorable characteristics. Stand up tall while pushing back against surface with arm.
Even free flaps may not be used without interposition of a vein. Request pdf on nov 1, 2008, yusuf kenan coban and others published banking parascapular flap for correction of severe axillary contracture among children find, read and cite all the research. This pedicle, responsible for flap irrigation, presents a vertical path, originating near the lateral margin of the scapula 7. Composite tissue defects of the mandible and maxilla, after resection of head and neck malignancies, osteoradionecrosis, malformations, or traumas, cause functional and aesthetic problems. The ideal method for resurfacing a defect near a joint is coverage with a flap. Medial sural artery perforator flap msap harvesting for head and neck microsurgical reconstruction. It is known for its use in chest wall and postmastectomy reconstruction and has also been used effectively for coverage of large soft tissue defects in the head and neck, either as a pedicled flap or as a microvascular free flap.
Here, we report our experience with the microvascular transfer of parascapular. Perineal 15x12 fasciacutaneous flap 21 m 45 322 bilateral axilla 15x8,15x10 12 parascapular fasciacutaneous flap 20 22 m 55 gluteal 10x12 7 local transposition flap 8 23 f 30 112 axilla 3x9 15 primary closure 16 inguinal 4x10 primary closure 24 f 32 0. The patients ranged in age from 27 to 83 years, with a mean age of 58 years. This webapp provides a simple way to merge pdf files. Methods from january 20 to december 15, 2016 patients 7 female and 8 male with a mean age of 47. The circumflex scapular artery perforator flap is an axial flap with the trilateral space perforator of circumflex scapular vessel as its vascular pedicle. This course has been designed to address the needs of the resident in plastic surgery wishing to learn flap dissection and the established practitioner who wishes to expand their current repertoire of flap surgery. This free online tool allows to combine multiple pdf or image files into a single pdf document. Defect reconstruction of the trochanter major after. Circumflex scapular artery perforator flap springerlink. When harvesting the scapular tip, it d and is a good guide for the direction of the pedicle and can help open the space over the pedicle. Free tissue transfer alone or in combination with traditional plastic surgery techniques has definitely become a useful tool for treatment of postburn defects and scars 68 in selected anatomical regions. Defects in head and neck after tumor resection often provide significant functional and cosmetic deformity.
Soda pdf is the solution for users looking to merge multiple files into a single pdf document. Impaired soft and hard tissue conditions as a sequelae of extensive surgical resection andor radiotherapy may impede common reconstruction methodes. Parascapular flap an overview sciencedirect topics. The challenge for reconstruction is not only the aesthetic result, but the functional repair. Easily combine multiple files into one pdf document. Pdf merge combine pdf files free tool to merge pdf online. Flap elevation the prepatterned flap is thinned in situ at the donor site except directly overlying the vascular pedicle. It provides a large goodquality skin flap that can cover all the aesthetic units of the neck without any microvascular anastomosis. Free parascapular flap for neck reconstruction with unusual pattern failure 115 int j burn trauma 2018. The company fulfills the market demand in a competitive way and with stateofthe art technologies based on research, experience and indepth technical knowledge over 200 employees working in several divisions, starting from the. Flap was well vascularized after performing end to end anastomoses with 100 monofilament suture of circumflex scapular artery to facial artery and the two commitant. Flap design in facial reconstruction is particularly delicate given the face is the most visible structure of the body and has some of the most complex threedimen.
The parascapular fasciocutaneous and latissimus dorsi muscle flaps can be raised together as a clinical example of a branchbased common conjoined flap. Dorsi fl ap scapular parascapular flap all faculty 15. Flapping or tapping, also known as alveolar flapping, intervocalic flapping, or tvoicing, is a phonological process found in many varieties of english, especially north american, australian and new zealand english, whereby the voiceless alveolar stop consonant phoneme t is pronounced as a voiced alveolar flap. At present there is no unified description of partial flap loss in terms of relatively how much of the flap volume or. How to merge pdfs and combine pdf files adobe acrobat dc. However, after 12 years of flap positioning in the face, the flap often takes on the color hue of the face due to environmental exposure. Interest in flaps based on the subscapular vascular system has decreased because of the need for intraoperative patient repositioning and the inability to employ a simultaneous 2team approach. In the normal population the muscle is quite thin less than 1 centimeter thick, allowing it to be draped over irregular surfaces with ease. Unusual pattern of partial failure of preexpanded free.
1557 1634 782 836 1455 267 1132 642 637 552 1058 731 3 1509 850 138 572 888 703 1204 297 805 1477 1141 347 988 215 808 624 527 748