This maneuver recreated the glossomandibular sulcus and established the height required for tonguetopalate contact. The world on your shoulders aka rotator cuff syndromes by dr. This latter technique needs a long flap that may not be possible in all cases. Scapular flaps fasciocutaneous, osteofasciocutaneous, cutaneous flap, parascapular cutaneous flap, latissimus dorsi myocutaneous flap, and serratus anterior flap thin, hairless skin two cutaneous flaps may be. Planning it eccentrically allows the flap to reach up to the lower third of the arm comfortably. The conjoined parascapular and latissimus dorsi free flap. The parascapular flap was described by nassif et al. Assessment technique for parascapular contribution to cervical pain. The deltoid free flap is a neurovascular fasciocutaneous tissue, providing relatively thin sensate tissue for use in softtissue reconstruction. Moving on from the conventional workhorse flap cover of latissimus dorsi muscle or myocutaneous flap, free fasciocutaneous flaps offer several. She is the author of six fitness books and holds an associate of arts in exercise science from oakland community college. Inferior glide 2 x 10 push arm straight down for 5 seconds. Original article a comparative study of tissue expansion. Use the download button below or simple online reader.
Periscapular strengthening program low row 3 x 8 stand with arm against firm surface. Defects in the forearm that leave only muscle exposed can generally be skin grafted. The pectoralis major flap can be used as a myocutaneous flap or simply as a muscular flap. The flap is harvested with descending branch of the circumflex scapular artery providing blood supply.
Stable longterm results and little donor site morbidity are enabled with good aesthetic outcomes and shorter operation time in an interdisciplinary twoteam approach. The anatomy of the parascapular flap allows it to be harvested with a large number of other flaps on a single pedicle. Flaps and reconstructive surgery by fuchan wei and samir. Complex reconstructions in head and neck cancer surgery. Both the scapular and parascapular flaps allow primary closure of the donor site with no functional loss to the shoulder. The patients ranged in age from 27 to 83 years, with a mean age of 58 years.
With downwardly rotated and depressed scapula, the upper trapezius, in addition to. This flap is most suitable for contracture of the anterior axillary fold. Parascapular flap an overview sciencedirect topics. The cutaneous scap ular flap was used in five cases and the osteocutaneous flap in 31 cases. Dorsi fl ap scapular parascapular flap all faculty 15. Fasciocutaneous flap reconstruction of the tongue and floor. The scapular free flap elrikrh journal of plastic surgery i 982 35, 27 c 1982 the trustees of british association of plastlc surgeons 0007. Fasciocutaneous or myocutaneous flaps from the back latissimus dorsi flap, parascapular flap or the thigh anterior lateral thigh alt.
Fractures of the talus or calcaneus with accompanying soft tissue damage. This study demonstrated the reconstructive advantages of the angular branchbased stff, long pedicle, low flap failure, 3dimensional nature of bone and soft tissues chimeric flap, and small rate of donor site morbidity with free ambulation. Exercises can be performed by using pillows to supports the ues when strengthening the parascapular muscles or retraining cervical motion. It provides a large goodquality skin flap that can cover all the aesthetic units of the neck without any microvascular anastomosis. This further enhanced the possibility of including any combination of skin, subcutaneous tissue, fascia, muscle and bone, if required, in the composite flap. Cancer may involve composite elements and the in sano resection may lead to an extensive tissue defect.
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. Stand facing a mirror with the hands rotated so that the thumbs face forward. No donorsite deficits occured following parascapular flap harvest. The parascapular fasciocutaneous and latissimus dorsi muscle flaps can be raised together as a clinical example of a branchbased common conjoined flap. Combined flap consisting of bone, fascia, and skin. A variant of the parascapular flap is the inframammary extended circumflex scapular. Ligating the horizontal branch allows a further mobilization of the pedicle by 23 cms. The scapularparascapular flap in reconstruction of distal lower. The free scapular flap for head and neck reconstruction michael j.
Pdf preexpanded extended island parascapular flap for. Thus they designed the skin paddle of this parascapular flap along the lateral border of the. With coverage of nearly twice the number of flaps as the previous edition, flaps and reconstructive surgery, 2nd edition provides trainees and practicing surgeons alike with the detailed, expert knowledge required to ensure optimal outcomes. The scapularparascapular flap is based on the circumflex scapular artery csa, which is a branch of the subscapular artery. This flap is an excellent option for use in complex threedimensional head and neck reconstruction. Parascapular flap main axis along lateral border of scapula. To overcome the problem of recurrence, several alternative techniques have been proposed. The introduction of alternative bonecontaining free flap donor sites, such as the iliac crest and fibula, is largely responsible for. Periscapular strengthening exercises home exercise program all exercises should be completed as three sets of 10 repetitions, unless otherwise noted. Original article the scapular osteofasciocutaneous flap. Try to raise the arm by hinging at the shoulder as opposed to raising the arm with the. During thumb reconstruction, the radialtoparascapular pedicle artery was found to be significantly narrowed, from 3 mm previously to less than 1 mm, suggesting reduced flap reliance on its pedicle. A mother of two and passionate fitness presenter, lisa m.
When used as a myocutaneous flap, a skin graft is also taken from the region of the lower breast fold, and this graft remains pedicled to the muscle and can be transposed into the head and neck region. Micro vascular free flaps used in head and neck reconstruction certified fixed orthodontic courses by indian dental academy. Greatest gains will be made when the muscles are warm. Stand up tall while pushing back against surface with arm. Keep arm at waist level while twisting trunk to help pinch shoulder blade scapula towards spine. The combined scapularparascapular flap for the treatment of. The skin island and the bone are oriented to the shape of the defect.
Osteocutaneous scapula free flap iowa head and neck. A free scapular flap was used to reconstruct head and neck defects in 36 patients between june 1986 and au gust 1989. It includes chapters and expert commentaries from more than 100 authors and worldrenowned leaders in the. Thyreophora from the upper jurassic morrison formation of wyoming, u. The first septocutaneous flaps based on the circumflex scapular artery were described in the late 1970s and became very popular in the 1980s because of their reliability and flexibility for complex head and neck reconstruction. These include the inner arm fasciocutaneous flap, the scapular island flap, the fasciocutaneous flap from the anterolateral or posterolateral aspects of the chest, the parascapular flap, and the free flap. The descending branch of the circumflex scapular artery. When not writing, wolfe is hulahooping, kayaking, walking or cycling. Aug 04, 2015 this study demonstrated the reconstructive advantages of the angular branchbased stff, long pedicle, low flap failure, 3dimensional nature of bone and soft tissues chimeric flap, and small rate of donor site morbidity with free ambulation.
Notes for exercises perform each exercise slow and controlled ice for 20 minutes 2 times a day if shoulder is sore. The scapularparascapular system of flaps is a unique system of flaps available for free tissue transfer based on the subscapular artery and its branches. Osteofasciocutaneous parascapular flap transfer for reconstruction of the first ray of the foot article pdf available in archives of orthopaedic and trauma surgery 1288. Postoperative radiographic and scintigraphic examination showed successful bridging of the bony defect and successfull integration of the osteomyocutan parascapular flap. Although the circumflex scapular artery is usually accompanied by two venae commitans, the subscapular artery is typically accompanied by one vein. Microvascular surgery protocols general considerations. Kelly rybicki the old saying the weight of the world on your shoulders well picturizes what it is like for someone with a shoulder issue. Oct 31, 2018 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. Five months before toetothumb transfer, a free parascapular perforator flap, anastomosed onto the radial artery in endtoend fashion, had been used to reconstruct the softtissue deficit. Type of free flaps used in all patients, in burn or highvoltage injuries, for primary or secondary reconstruction type of free. A total of 15 patients with free parascapular flap and 15 patients with tissue expansion followed by flap advancement were analyzed in the group. Wolfe had her first fitness article published in 2001. The file extension pdf and ranks to the documents category. The flap can be larger in width than the scapular flap, approaching 15 cm and has been harvested as long as 25 cm.
After performing several free style flaps, the technique and the entire. The pectoralis major muscle is supplied by a dominant vascular pedicle. This chapter details the steps in performing a free parascapular flap for head and neck reconstruction. During thumb reconstruction, the radialto parascapular pedicle artery was found to be significantly narrowed, from 3 mm previously to less than 1 mm. Parascapular free flaps for head and neck reconstruction b. The pedicle was divided and backflow noted, confirming an independent blood.
Frontiers a standard algorithm for reconstruction of scalp. The inner arm fasciocutaneous flap may not be available in some cases. Osteocutaneous scapula free flap iowa head and neck protocols. The flaps vein was anastomosed to the venous branch accordingly. Use of the parascapular flap in hand reconstruction. This combination allows the creation of an extremely large cutaneous flap from the dorsal thorax while ensuring survival of both the muscle and skin. Readdownload file report abuse peroneal perforator pedicle propeller flap for lower leg soft tissue lower leg and to explore the use of perforator pedicle propeller flaps to repair soft tissue defects in the lower leg, heel and foot. In 1978, saijo was the first to describe the scapular fasciocutaneous flap anatomy based on the circumflex scapular artery csa.
Oct 29, 2015 in these situations, free flaps form an additional and pivotal tool in the armamentarium of plastic surgery. Type of free flap ten flaps 40 percent were cutaneous flaps tensor fasciae latae fig. The challenge for reconstruction is not only the aesthetic result, but the functional repair. Ateriovenous subclaviashunt for head and neck reconstruction.
Pdf osteofasciocutaneous parascapular flap transfer for. Shoulder strengthening exercises should be completed 34 times per day and should be done to both sides. The introduction of alternative bonecontaining free flap donor sites, such as the iliac crest and fibula, is largely responsible for this decline. The subscapular artery pedicle can be from 3 to 7 cm in length with vessel circumference at this level up to 4 millimeters in size. A comparison is presented of free myocutaneous flaps, e. Scapular tip free flap for head and neck reconstruction. Periscapular strengthening program lawnmower 2 x 12 begin with arm down. Posts about parascapular stabilization written by onionriverchiro.
However, distal to the musculotendinous junctions, defects often require flap coverage to provide a stable soft tissue closure over tendons that will allow gliding. Free fasciocutaneous parascapular or scapular flaps are a powerful tool for preventing infection if local flaps are not sufficient to achieve stable soft tissue. Baker, md, rosann crompton, pt, and michael smithwheelock, pt the free scapular flap is a versatile flap for soft tissue and bony reconstruction of the head and neck. This pedicle, responsible for flap irrigation, presents a vertical path, originating near the lateral margin of the scapula 7. The deltoid fasciocutaneous flap was first described anatomically and applied clinically by franklin. Defects in head and neck after tumor resection often provide significant functional and cosmetic deformity. Arterial anastomosis around the scapula upper limb gross anatomy usmle step 1 videos duration. The parascapular flap provides a fasciocutaneous flap with similar characteristics to those of the scapular flap. The combined scapular parascapular flap was used for coverage of six high voltage electrical burn defects of upper extremity. Redundant flap edge at the anterior aspect was then elevated cephalad with a skin hook, and the unattached margins of the flap were sutured vertically in the midline figure 4b. No prospective randomized controlled studies for comparison of different free flaps are. Thoracic wall reconstruction after tumor resection frontiers. Oct 17, 2014 combined flap consisting of bone, fascia, and skin.
One necrosis of a parascapular flap occurred and made a latissimus dorsi flap necessary. The parascapular branch forms the basis of the parascapular flap. The main cosmetic shortcoming is the dogear which is noticeable when the arm is adducted. However, i do not understand the difference when a doc says periscapular versus parascapular. The combined parascapular fasciocutaneous and latissimus dor. The parascapular microvascular flap has become a workhorse in the correction of facial asymmetry. Indications the scapula fasciocutaneous flap is now used infrequently due to the emergence of the forearm flap for oral and pharyngeal soft tissue reconstruction. This can be done by keeping the arms supported throughout daily life by crossing arms when standing or walking, adjusting arm rests to appropriate height, and avoiding carrying anything heavy. Request pdf free scapular or parascapular flaps for soft tissue damage accompanying talus or calcaneus fractures. Frontiers a standard algorithm for reconstruction of.
The combined parascapular fasciocutaneous and latissimus. The parascapular flap and the anterolateral thigh flap are both excellent choices for such wounds. Fifteen parascapular flaps based on the oblique branch of the. The parascapular flap and its variations have been described extensively. Bhanu prakash usmle, fmge and neet pg 67,594 views. Scapular and parascapular free tissue transfer treatment.
Terz, md, duarte, california we report our experience with singlestage, pri mary reconstruction of the head and neck in 29 consecutive patients using parascapular free flaps. Fasciocutaneous flap reconstruction of the tongue and. Free parascapular flap for neck reconstruction with unusual pattern failure 115 int j burn trauma 2018. Scapularperiscapular exercises table slides abduction 2 x 10 slide arm and body together across table. Parascapular free flaps for head and neck reconstruction. The scapularparascapular flap in reconstruction of distal lower extremity soft tissue defects over the achilles tendon.
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