Atlas of Regional and Free Flaps for Head and Neck Reconstruction - Flap Harvest and Insetting

This Atlas depicts in a clear manner the use of regional skin, muscle and musculocutaneous flaps as well as donor sites
from distant regions of the body where vascularized skin, muscle, bone, and nerves can be harvested and transferred to
the head and neck. Otolaryngologists, plastic surgeons and general surgeons use both regional and free flaps to
reconstruct damage to the head and neck caused by cancer and trauma. This Atlas provides the surgeon with techniques
for mastering different donor sites needed to find solutions to virtually every reconstruction problem. It provides
detailed descriptions of the anatomy and harvesting techniques of the major regional and free-flap donor sites
currently employed in head and neck reconstruction.

--NEW Add chapters on submental flap, ulnar forearm flap, anterolateral thigh flap, paramedian forehead flap,
cervicofacial advancement flap, perforator flaps
--NEW Add harvest of the coronoid process to the temporalis chapter
--NEW Add harvest of the osteocutaneous radial forearm flap to the radial forearm flap chapter
--NEW Add harvest of the scalp to the chapter on temporoparietal fascial flap
--NEW Add harvest of the scapular tip for use in palatomaxillary reconstruction to the scapular flap chapter
--NEW Add to harvest of the IMA and IMV recipient vessels and harvest of the TAC system of vessels to the recipient
vessel chapter
--NEW Add to harvest of the IMA and IMV recipient vessels and harvest of the TAC system of vessels to the recipient
vessel chapter
--NEW Demonstrate flap insetting and design for a number of reconstructions
--NEW Eliminate chapters on lateral thigh and masseter muscle flaps
--Beautiful four-color line drawings of harvesting of all flaps
--Full discussion of the anatomy, flap design and utilization, anatomic variations, preoperative and postoperative
care, potential pitfalls and harvesting techniques for each donor site
--Uses fresh cadaver dissections to provide the most realistic portrayal of step-by-step detail that gives the resident
and attending surgeon a thorough understanding of each donor site



TAble of Contents

Contributors vi


Foreword vii


Preface ix


Acknowledgements xiii

PART 1
REGIONAL FLAPS 1


Muscle and Musculocutaneous Flaps


Chapter 1
Pectoralis Major Mark L. Urken 3


Flap Harvest Techniques



Pectoralis Major Flap 20

Chapter 2
Trapezius System Mark L. Urken 27


Flap Harvest Techniques



Superior Trapezius Flap 37


Lateral Island Trapezius Flap 39


Lower Trapezius Island Musculocutaneous Flap 42

Chapter 3
Temporalis Tessa A. Hadlock, Robin W. Lindsay, and Mack L Cheney 47


Muscular Anatomy of the Face 52


Flap Harvest Techniques



Temporalis Muscle 53


Temporalis Muscle Tendon 56

Chapter 4
Sternocleidomastoid Mark L. Urken 59


Flap Harvest Techniques



Sternocleidomastoid Flap 72


Cutaneous and Fasciocutaneous Flaps


Chapter 5
Deltopectoral Mark L. Urken 76


Flap Harvest Techniques



Deltopectoral Flap 86

Chapter 6
Anterior and Posterior Scalp Mack L. Cheney and Mark L. Urken 89


Flap Harvest Techniques



Anterior Scalping Flap Dissection 94


Posterior Scalping Flap Dissection 98

Chapter 7
The Submental Island Mark L Urken 102


Flap Harvest Techniques



Submental Flap 111

Chapter 8
Paramedian Forehead Tessa A. Hadlock, Robin W. Lindsay, and Mack L Cheney 122


Flap Harvest Techniques



Paramedian Forehead Flap 124


Calvarial Bone Graft 127


Mucosal Flaps


Chapter 9
Palatal Island Mark L. Urken 130


Flap Harvest Techniques



Palatal Island Flap 133


Flap Inset Techniques



Palatal Island Flap 137

PART 2
FREE FLAPS 139


Muscle and Musculocutaneous Flaps


Chapter 10
Rectus Abdominis Mark L, Urken and Keith E. Blackweli 141


Flap Harvest Techniques



Rectus Abdominis Flap (Extended Deep Inferior Epigastric Flap) 152


Rectus Abdominis Flap (Deep Inferior Epigastric Perforator Flap) 158

Chapter 11
Gracilis Tessa A. Hadlock, Robin W. Lindsay, and Mack L. Cheney 162


Flap Harvest Techniques



Gracilis Flap 168


Flap Inset Techniques



Gracilis Muscle for Facial Reanimation 777


Anastomosis of Cross Facial Nerve Graft to Obturator Nerve 172


Isolation of Masseteric Motor Nerve 173


Reinnervation of the Masseteric Nerve and Bilateral Gracilis Muscle Transfer 174


Fascial and Fasciocutaneous Flaps


Chapter 12
Radial Forearm Mark L. Urken and Jeffrey R. Harris 176


Flap Harvest Techniques



Radial Forearm Fasciocutaneous Flap 187


Beavertail Modification of the Radial Forearm Flap 192


Flap Inset Techniques



Insetting of the Radial Forearm Flap for Pharyngoesophageal Reconstruction 196


Inset of the Radial Forearm Cutaneous Flap for Reconstruction of the Circumferential Pharyngoesophageal Segment 198


Inset of the Radial Forearm Flap for L engthening of the Mediastinal Trachea 201

Chapter 13
Lateral Arm Mark L Urken 206


Flap Harvest Techniques L Lateral Arm Flap 212

Chapter 14
Temporoparietal Fascia Mack L Cheney, Robin W. Lindsay, and Tessa A. Hadlock 219


Flap Harvest Techniques Tempoparietal Fascial Flap 227


Tempoparietal Fasciocutaneous Flap 231

Chapter 15
Anterolateral Thigh Free Flap Keith E. Blackwell 234


Flap Harvest Techniques



Anterolateral Thigh Flap 243


Flap Inset Techniques



Inset of the Anterolateral Thigh Flap for Circumferential Pharyngoesophageal Reconstruction 249

Chapter 16
Posterior Tibia I Artery Free Flap Jeffrey R.Harris 257


Flap Harvest Techniques



Posterior Tibia! Artery Flap
266

Chapter 17
Ulnar Forearm Free Flap Jeffrey R. Harris and Arjun Joshi 272


Flap Harvest Techniques



Ulnar Forearm Free Flap
282


Composite Free Flaps


Chapter 18
Subscapular System Mark L. Urken 288

Chapter 19
Scapular and Parascapular Fasciocutaneous and Osteofasciocutaneous and Subscapular Mega Flap Mark L. Urken 292


Flap Harvest Techniques



Scapular Osteocutaneous Flap 307


Scapular-Latissimus Dorsi 밠ega Flap� 309


The Scapular Tip Based on the Angular Branch and the Parascapular Flap 313


Flap Inset Techniques



Inset of Scapular Osteocutaneous Flap-Latissimus Dorsi Flap for Mandibuiar Reconstruction 320


Reconstruction of the Hemipalatal Shelf with a Half of the Scapular Tip 322


Reconstruction of the Total Palatal Defect with the Scapular Tip Osteocutaneous Flap 323

Chapter 20
Latissimus Dorsi and Serratus Anterior Mark L. Urken and Keith E. Blackwell 326


Flap Harvest Techniques



Latissimus Dorsi Myocutaneous Flap 343


Flap Harvest and Inset Techniques



Latissimus-Dorsi-Serratus Anterior-Rib Osteomyocutaneous Flap for Oromandibular Reconstruction 351

Chapter 21
Iliac Crest Osteocutaneous and Osteomusculocutaneous Mark L. Urken 359


Flap Harvest Techniques



Iliac Crest-Internal Oblique Flap 372


Synthetic Mesh Closure of the Abdominal Wall 385


Closure of the Abdominal Wall 389


Iliac Crest Osteocutaneous Flap 390


Flap Inset Techniques



Inset of Right Iliac Crest-Internal Oblique Composite



Flap to Reconstruct a Right Oromandibular Defect 393


Inset of Left Iliac Crest-Internal Oblique Musculocutaneous



Flap to Reconstruct an Anterolateral Mandibuiar Defect 395


Reconstruction of a Right Total Maxillectomy Defect with a Right Iliac Crest-Internal Oblique Flap 398

Chapter 22
Fibular Osteocutaneous Mark L. Urken and Neal Futran 404


Flap Harvest Techniques



Fibular Osteocutaneous Flap 413


Sensate Fibular Osteocutaneous Flap 474


Fibular Osteocutaneous Flap 475


Flap Inset Techniques



Orientation of the Fibular Osteocutaneous Flap Relative to the Laterality of the Leg of Harvest and the Position of
the Cutaneous Paddle and the Donor Vascular Pedicle 419


Contour and Rigid Fixation of the Fibular Free Flap to Reconstruct a Right Hemirnandibular Defect 421


Management of the Resected Mandibular Condyle 428


Contouring and Inset of a Flight Double Barreled Fibular Flap to Reconstruct a Right Hemtmandibulectomy Defect 434


Contouring and Fixation of a Fibular Osteocutaneous Flap for Reconstruction of a Right Infrastructure MaxiIlectomy
Defect
436

Chapter 23
Osteocutaneous Radial Forearm Free Flap Neal Futran 445


Flap Harvest Techniques



Radial Forearm Osteocutaneous Flap 450


Visceral Flaps


Chapter 24
Free Jejunal Autograft Mark L Urken and Allan M. Goldstein 455


Flap Harvest Techniques



Harvest of Free Jejunal Autograft 466


Flap Inset Techniques Reconstruction of a Circumferential PharyngoesophagealDefect 468

Chapter 25
Free Omentum and Gastro-Omentum Mark L. Urken and Allan M. Goldstein 475


Flap Harvest Techniques



Tubed Gastro-Omenta! Free Flap 481


Flap Inset Techniques Reconstruction of Circumferential Pharyngoesophageal Defect 484

PART 3
NERVE GRAFT DONOR SITES 489

Chapter 26
Medial Antebrachial Cutaneous Nerve Graft Robin W. Lindsay, Tessa A. Hadlock, and Mack L. Cheney 491


Flap Harvest Techniques Medial Antebrachial Cutaneous Nerve 494

Chapter 27
Sural Nerve Graft Robin W. Lindsay, Tessa A. Hadlock, and Mack L. Cheney 497


Flap Harvest Techniques Sural Nerve Graft 500

PART 4
TECHNICAL CONSIDERATIONS IN FREE TISSUE TRANSFERS 503

Chapter 28
Recipient Vessel Selection in Free Tissue Transfer to the Head and Neck Mark L. Urken 505


Recipient Vessel Harvest Techniques



Harvest of the Lingua! Artery in Lessers Triangle 510


Harvest of the TAC System of Recipient Vessels 512


Harvest of the Internal Mammery Artery and Vein 516


Index 521