SOFT TISSUE COVERAGE OF THE UPPER LIMB

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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 SITE

FOR 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